Gregory Brenton Queen, MS, LMFT, LCAS

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1107 Issued in NC

Practice address

825 3Rd Ave NW Ste 2
Hickory, NC 28601-4806

Phone

(704) 534-7110

NPI assigned

Nov 9, 2006

Last updated

Dec 13, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Recreated PLLC

  • Marriage & Family Therapist
  • Hickory, NC
  • NPI 1154006104
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1548330905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 3RD AVE NW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286014806",
            "telephone_number": "704-534-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 3RD AVE NW STE 2",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286014806",
            "telephone_number": "704-534-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "GREGORY",
        "middle_name": "BRENTON",
        "credential": "MS, LMFT, LCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "1107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6105107",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Debbie L Punch, LCAS-A
• R & C Clinic Inc
• R. Gary Hensley DMD, PA II (Viewmont Family Dentristry)
• Jessica Raby, CCC-SLP
• Michael E Radford, CRNA
• Dan Radulescu, ANP

• Marriage & Family Therapist in Hickory, NC
• Providers in Hickory, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.