Provider Demographics
NPI:1437200763
Name:MCQUEENEY, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MCQUEENEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 BAINBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1619
Mailing Address - Country:US
Mailing Address - Phone:770-993-1876
Mailing Address - Fax:770-993-3139
Practice Address - Street 1:327 DAHLONEGA ST
Practice Address - Street 2:BLDG 1600
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2480
Practice Address - Country:US
Practice Address - Phone:770-317-3365
Practice Address - Fax:770-993-3139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000682103TB0200X, 103TC2200X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000237784FMedicaid