Provider Demographics
NPI:1497378194
Name:MADISON, ADELLE RAE (LPCC-S)
Entity Type:Individual
Prefix:
First Name:ADELLE
Middle Name:RAE
Last Name:MADISON
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8405
Mailing Address - Country:US
Mailing Address - Phone:330-507-5642
Mailing Address - Fax:
Practice Address - Street 1:7105 HERBERT RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8660
Practice Address - Country:US
Practice Address - Phone:330-533-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health