Provider Demographics
NPI:1780401083
Name:QUEENS ENRICHMENT AND THERAPEUTIC ORGANIZATION
Entity type:Organization
Organization Name:QUEENS ENRICHMENT AND THERAPEUTIC ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER-LCSW-A
Authorized Official - Phone:704-963-6165
Mailing Address - Street 1:3917 FARLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0196
Mailing Address - Country:US
Mailing Address - Phone:704-963-6165
Mailing Address - Fax:
Practice Address - Street 1:3917 FARLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0196
Practice Address - Country:US
Practice Address - Phone:704-963-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health