Provider Demographics
NPI:1447740139
Name:MADRONE, MARIE (LMHC, SUDP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MADRONE
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:SFIRAH
Other - Middle Name:
Other - Last Name:MADRONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 SE WHITENER RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7747
Mailing Address - Country:US
Mailing Address - Phone:360-426-1582
Mailing Address - Fax:
Practice Address - Street 1:100 SE WHITENER RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7747
Practice Address - Country:US
Practice Address - Phone:360-426-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60791238101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health