Provider Demographics
NPI:1578735114
Name:QUEEN, KYOKO OKAZAKI (MA, NCC, LCPC, LPC,)
Entity Type:Individual
Prefix:MS
First Name:KYOKO
Middle Name:OKAZAKI
Last Name:QUEEN
Suffix:
Gender:F
Credentials:MA, NCC, LCPC, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 FLORIDA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7123
Mailing Address - Country:US
Mailing Address - Phone:240-354-5575
Mailing Address - Fax:
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:240-354-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13841101YM0800X
MDLC1590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health