Provider Demographics
NPI:1336701564
Name:TUTTLE, MADISON FAITH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:FAITH
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CHANCELLORS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6073
Mailing Address - Country:US
Mailing Address - Phone:919-943-5528
Mailing Address - Fax:
Practice Address - Street 1:1777 FORDHAM BLVD STE 202-3
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5859
Practice Address - Country:US
Practice Address - Phone:919-943-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0138101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical