Provider Demographics
NPI:1134680739
Name:MORRIS, MADELEINE (LPCA)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 VICTOR PL APT 1E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1776
Mailing Address - Country:US
Mailing Address - Phone:843-209-0860
Mailing Address - Fax:
Practice Address - Street 1:2709 PINEDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2018
Practice Address - Country:US
Practice Address - Phone:336-288-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health