Provider Demographics
NPI:1396447348
Name:MCQUEEN, GEORGIANA PATRICE
Entity type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:PATRICE
Last Name:MCQUEEN
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 1:1620 TURKEY RUN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7643
Mailing Address - Country:US
Mailing Address - Phone:910-583-9556
Mailing Address - Fax:
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3121
Practice Address - Country:US
Practice Address - Phone:910-506-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health