Provider Demographics
NPI:1689371528
Name:MCDANIEL, MADISON (LCSWA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 CENTER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7435
Mailing Address - Country:US
Mailing Address - Phone:704-456-8286
Mailing Address - Fax:
Practice Address - Street 1:4047 CENTER PLACE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7435
Practice Address - Country:US
Practice Address - Phone:704-456-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical