Provider Demographics
NPI:1275975484
Name:CROSS, QUANNA LA'KISHA (LPC)
Entity type:Individual
Prefix:MRS
First Name:QUANNA
Middle Name:LA'KISHA
Last Name:CROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DR
Mailing Address - Street 2:207B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2415
Mailing Address - Country:US
Mailing Address - Phone:803-556-9439
Mailing Address - Fax:803-419-7497
Practice Address - Street 1:2712 MIDDLEBURG DR
Practice Address - Street 2:207B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2415
Practice Address - Country:US
Practice Address - Phone:803-556-9439
Practice Address - Fax:803-419-7497
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional