Provider Demographics
NPI:1003452988
Name:MORAN, MADELINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAGNOLIA GLEN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4278
Mailing Address - Country:US
Mailing Address - Phone:843-997-0429
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 213
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4234
Practice Address - Country:US
Practice Address - Phone:512-607-9360
Practice Address - Fax:877-775-9422
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82379101YM0800X
SC7478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health