Provider Demographics
NPI:1649243312
Name:DAVIDIAK, MADELYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:
Last Name:DAVIDIAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6399
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-6399
Mailing Address - Country:US
Mailing Address - Phone:501-620-5318
Mailing Address - Fax:501-620-5112
Practice Address - Street 1:505 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3931
Practice Address - Country:US
Practice Address - Phone:501-620-5318
Practice Address - Fax:501-620-5112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR875-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker