Provider Demographics
NPI:1366158545
Name:THE QUEEN'S HEALING TOUCH, PLLC
Entity type:Organization
Organization Name:THE QUEEN'S HEALING TOUCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-944-0560
Mailing Address - Street 1:1014 HOMELAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7015
Mailing Address - Country:US
Mailing Address - Phone:336-944-0560
Mailing Address - Fax:
Practice Address - Street 1:1012 HOMELAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7004
Practice Address - Country:US
Practice Address - Phone:336-944-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)