Provider Demographics
NPI:1346769544
Name:HERBERT, QUEENESHA GRACE MAEDELL (LCPC, DBT-C)
Entity Type:Individual
Prefix:
First Name:QUEENESHA
Middle Name:GRACE MAEDELL
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LCPC, DBT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 CHERRY HILL RD APT 615
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1238
Mailing Address - Country:US
Mailing Address - Phone:240-316-4666
Mailing Address - Fax:
Practice Address - Street 1:9308 CHERRY HILL RD APT 615
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1238
Practice Address - Country:US
Practice Address - Phone:240-316-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLC10055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health