Provider Demographics
NPI:1174671861
Name:MCQUEEN, ROBERT C JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:MCQUEEN
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:7985 COLEE COVE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2306
Mailing Address - Country:US
Mailing Address - Phone:904-651-3237
Mailing Address - Fax:904-217-8623
Practice Address - Street 1:4711 HWY 17S.
Practice Address - Street 2:STE. C-4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-651-3237
Practice Address - Fax:904-217-8623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1808101YA0400X
FLMH-4271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)