Provider Demographics
NPI:1720538549
Name:QUEEN, LEKETA (RSW)
Entity Type:Individual
Prefix:
First Name:LEKETA
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 CARTER ST # B
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3143
Mailing Address - Country:US
Mailing Address - Phone:318-414-3067
Mailing Address - Fax:
Practice Address - Street 1:1644 CARTER ST # B
Practice Address - Street 2:SUITE 2
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3143
Practice Address - Country:US
Practice Address - Phone:318-414-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker