Provider Demographics
NPI:1154068120
Name:QUEEN, SHERILYN MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHERILYN
Middle Name:MARIE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SUMMERSET LN
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1663
Mailing Address - Country:US
Mailing Address - Phone:229-560-1218
Mailing Address - Fax:
Practice Address - Street 1:125 N CORNERS PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2078
Practice Address - Country:US
Practice Address - Phone:678-341-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist