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General NPI Number Information
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NPI Number | 1497684815
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Entity Type | Organization
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Legal Business Name | QUEENDOM COME COACHING, LLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 221 AVENDELL DR
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City | EASLEY
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State | SC
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Zip | 29642-7608
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Country | US
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Telephone | 864-551-3299
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Fax |
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Provider Business Mailing Address
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Address Line | 221 AVENDELL DR
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City | EASLEY
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State | SC
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Zip | 29642-7608
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Country | US
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Telephone | 864-551-3299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMARIS MARTIN GIBSON
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Credential | LPC, PMH-C
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Telephone | 864-551-3299
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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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