Provider Demographics
NPI:1437641594
Name:RAINES, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1900
Mailing Address - Country:US
Mailing Address - Phone:304-927-0015
Mailing Address - Fax:304-927-0017
Practice Address - Street 1:811 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1900
Practice Address - Country:US
Practice Address - Phone:304-927-0015
Practice Address - Fax:304-927-0017
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor