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General NPI Number Information
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NPI Number | 1487962114
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Entity Type | Individual
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Provider Name | ASHLEY RENAE QUEEN MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 13262 LASSELLE ST APT 2011
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City | MORENO VALLEY
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State | CA
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Zip | 92553-0832
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Country | US
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Telephone | 951-256-7829
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Fax |
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Provider Business Mailing Address
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Address Line | 9191 MYRNA DR
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City | GASTONIA
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State | NC
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Zip | 28056-9531
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Country | US
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Telephone | 951-256-7829
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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