Healthcare Provider Details

I. General information

NPI: 1366158545
Provider Name (Legal Business Name): THE QUEEN'S HEALING TOUCH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 10/19/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 HOMELAND AVE STE 104
GREENSBORO NC
27405-7004
US

IV. Provider business mailing address

1014 HOMELAND AVE STE 101
GREENSBORO NC
27405-7015
US

V. Phone/Fax

Practice location:
  • Phone: 336-944-0560
  • Fax:
Mailing address:
  • Phone: 336-944-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JACQUENA MCIVER
Title or Position: OWNER
Credential:
Phone: 336-944-0560