Provider Demographics
NPI:1093290751
Name:ERICKSEN, MADISON ELIZABETH (LCMHC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N DOUGHERTY ST
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3353
Mailing Address - Country:US
Mailing Address - Phone:828-406-0667
Mailing Address - Fax:
Practice Address - Street 1:305 N DOUGHERTY ST
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3353
Practice Address - Country:US
Practice Address - Phone:828-406-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13817101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health