Provider Demographics
NPI:1083299903
Name:MADDISON, ALVIN EDWARD (MA NCC LPC)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:EDWARD
Last Name:MADDISON
Suffix:
Gender:M
Credentials:MA NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1013
Mailing Address - Country:US
Mailing Address - Phone:856-313-8810
Mailing Address - Fax:
Practice Address - Street 1:395 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1013
Practice Address - Country:US
Practice Address - Phone:856-313-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00224200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional