Individual
ASHLEY RENAE QUEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
13262 LASSELLE ST APT 2011, MORENO VALLEY, CA 92553-0832
(951) 256-7829
Mailing address
9191 MYRNA DR, GASTONIA, NC 28056-9531
(951) 256-7829
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487962114
—
CA
Enumeration date
09/15/2010
Last updated
11/25/2022
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