Provider Demographics
NPI:1639742653
Name:ALVAREZ, MADISON BROOK (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOK
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 GAY RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-6390
Mailing Address - Country:US
Mailing Address - Phone:919-710-2467
Mailing Address - Fax:
Practice Address - Street 1:5509 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6312
Practice Address - Country:US
Practice Address - Phone:919-573-6520
Practice Address - Fax:919-573-6555
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health