Provider Demographics
NPI:1780189357
Name:HANSEN, MADISEN KAE (MS, CACP)
Entity Type:Individual
Prefix:
First Name:MADISEN
Middle Name:KAE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 HIBISCUS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4715
Mailing Address - Country:US
Mailing Address - Phone:843-513-9944
Mailing Address - Fax:
Practice Address - Street 1:1668 HERLONG CT
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1193
Practice Address - Country:US
Practice Address - Phone:803-323-6384
Practice Address - Fax:803-328-2860
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)