Provider Demographics
NPI:1629305644
Name:TERRILL, MADILYN (LCPC)
Entity Type:Individual
Prefix:
First Name:MADILYN
Middle Name:
Last Name:TERRILL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5544
Mailing Address - Country:US
Mailing Address - Phone:207-613-0415
Mailing Address - Fax:207-480-1562
Practice Address - Street 1:74 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5544
Practice Address - Country:US
Practice Address - Phone:207-613-0415
Practice Address - Fax:207-480-1562
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3583101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor