MEDICARE: QUEENESHA GRACE MAEDELL HERBERT LCPC, ACS, C-DBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	LC10055	MD

General Provider Information

NPI Number	:	1346769544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUEENESHA GRACE MAEDELL HERBERT LCPC, ACS, C-DBT

Provider Business Mailing Address
First Line	:	5557 BALTIMORE AVE STE 500-2084
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	240-316-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5557 BALTIMORE AVE STE 500-2084
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1922
Country	:	US
Telephone Number	:	240-316-4666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	08/07/2025

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