Provider Demographics
NPI:1376111070
Name:CROWNS FOR QUEENS
Entity Type:Organization
Organization Name:CROWNS FOR QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-323-8737
Mailing Address - Street 1:10120 TWO NOTCH RD STE 166
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:803-999-6803
Mailing Address - Fax:
Practice Address - Street 1:213 JEFFERS CIR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9258
Practice Address - Country:US
Practice Address - Phone:843-323-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty