Individual
QUEEN WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
521 CLANTON RD, CHARLOTTE, NC 28217-1369
(704) 755-0150
Mailing address
521 CLANTON RD, CHARLOTTE, NC 28217-1369
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-26319
NC
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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