Provider Demographics
NPI:1407635782
Name:KILBY-QUEEN, CYNTHIA DARLENE (LCAS, LCMHCA, CADC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DARLENE
Last Name:KILBY-QUEEN
Suffix:
Gender:F
Credentials:LCAS, LCMHCA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 CARTPATH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-8250
Mailing Address - Country:US
Mailing Address - Phone:336-978-2717
Mailing Address - Fax:
Practice Address - Street 1:633 CARTPATH RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8250
Practice Address - Country:US
Practice Address - Phone:336-978-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19638101YM0800X
NCLCAS-26257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health