Healthcare Provider Details

I. General information

NPI: 1558666354
Provider Name (Legal Business Name): RON E. MCQUEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MEMORIAL DR
PINEHURST NC
28370-8712
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR. SUITE 100
CONCORD NC
28205-1894
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-6853
  • Fax:
Mailing address:
  • Phone: 704-939-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: