Individual
KELLY QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2825 LIVERNOIS RD, TROY, MI 48083-1214
(248) 680-2060
Mailing address
2825 LIVERNOIS RD, TROY, MI 48083-1214
(248) 680-2060
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401007827
MI
101YP2500X
Professional Counselor
Primary
6401007827
MI
Other
Enumeration date
09/20/2006
Last updated
04/03/2024
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