Provider Demographics
NPI:1134514987
Name:TOLAND, MADELINE JEAN PROEHL (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:JEAN PROEHL
Last Name:TOLAND
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:JEAN
Other - Last Name:PROEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5027
Mailing Address - Fax:704-316-5028
Practice Address - Street 1:845 CHURCH ST N STE 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-316-5027
Practice Address - Fax:704-316-5028
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11579101YP2500X
NC11579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional