Provider Demographics
NPI:1306149059
Name:QUEEN, JOSHUA M (MED, LPCI, NCC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:QUEEN
Suffix:
Gender:M
Credentials:MED, LPCI, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8591
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8591
Mailing Address - Country:US
Mailing Address - Phone:864-918-6416
Mailing Address - Fax:
Practice Address - Street 1:2 SEVIER ST
Practice Address - Street 2:2A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2934
Practice Address - Country:US
Practice Address - Phone:864-918-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional