Provider Demographics
NPI:1497510432
Name:GLACKIN, MADISON (MA, LCMHC-A)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:GLACKIN
Suffix:
Gender:F
Credentials:MA, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 GEORGE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2948
Mailing Address - Country:US
Mailing Address - Phone:828-222-0401
Mailing Address - Fax:888-876-4026
Practice Address - Street 1:1915 GEORGE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2948
Practice Address - Country:US
Practice Address - Phone:828-222-0401
Practice Address - Fax:888-876-4026
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health