Provider Demographics
NPI:1083807192
Name:PATALANO, MADELINE (LPC, LPA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PATALANO
Suffix:
Gender:F
Credentials:LPC, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 AULTROY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-3562
Mailing Address - Country:US
Mailing Address - Phone:910-850-1274
Mailing Address - Fax:888-588-7183
Practice Address - Street 1:1304 AULTROY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3562
Practice Address - Country:US
Practice Address - Phone:910-850-1274
Practice Address - Fax:888-588-7183
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103762Medicaid