Provider Demographics
NPI:1437029881
Name:GRAVES, QUANDARIA TAJANIQUE
Entity type:Individual
Prefix:
First Name:QUANDARIA
Middle Name:TAJANIQUE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 GILLISON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PINELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29934-5823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3061 GILLISON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PINELAND
Practice Address - State:SC
Practice Address - Zip Code:29934-5823
Practice Address - Country:US
Practice Address - Phone:270-498-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst