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General NPI Number Information
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NPI Number | 1174671861
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Entity Type | Individual
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Provider Name | ROBERT C MCQUEEN JR. LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 4711 HWY 17S. STE. C-4
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City | ORANGE PARK
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State | FL
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Zip | 32003
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Country | US
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Telephone | 904-651-3237
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Fax | 904-217-8623
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Provider Business Mailing Address
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Address Line | 7985 COLEE COVE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-2306
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Country | US
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Telephone | 904-651-3237
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Fax | 904-217-8623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1808
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH-4271
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License Number State | FL
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