Provider Demographics
NPI:1447824677
Name:MCILWAINE, QUADASHA D (MSW, LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:QUADASHA
Middle Name:D
Last Name:MCILWAINE
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 PIMILICO TRACE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7803
Mailing Address - Country:US
Mailing Address - Phone:704-909-1000
Mailing Address - Fax:
Practice Address - Street 1:648 S JONES AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5841
Practice Address - Country:US
Practice Address - Phone:704-909-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0137921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical