Provider Demographics
NPI:1598885105
Name:GILL, MADELEINE H (LPC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:H
Last Name:GILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:119 S BURROWES ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3863
Mailing Address - Country:US
Mailing Address - Phone:814-861-7133
Mailing Address - Fax:814-238-1875
Practice Address - Street 1:119 S BURROWES ST
Practice Address - Street 2:SUITE 703
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3863
Practice Address - Country:US
Practice Address - Phone:814-861-7133
Practice Address - Fax:814-238-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional