| Doctor Name: | MICHELLE QUEEN |
| NPI Number: | 1619261427 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 001573 |
| Business Practice Address: | 710 Main Street Plantsville, CT - 06479 |
| Business Phone Number: | 8603842523 |
| Business Fax Number: | |
| Mailing Address: | 49 James Ave, SOUTHINGTON |
| State: | CT |
| Postal Code: | 064892324 |
| Phone Number: | 8603842523 |
| Fax Number: | |
| NPI Enumeration Date: | 06/09/2011 |
| NPI Last Update Date: | 08/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 001573 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |