Provider Demographics
NPI:1790227635
Name:HASKELL, MADISON MARIE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:HASKELL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FARMERS FOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8572
Mailing Address - Country:US
Mailing Address - Phone:704-962-8919
Mailing Address - Fax:
Practice Address - Street 1:125 OVERHILL DR STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8232
Practice Address - Country:US
Practice Address - Phone:704-962-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist