Provider Demographics
NPI:1922286442
Name:MADISON, KATHLEEN RUTH (LPC, CRC, MRC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:MADISON
Suffix:
Gender:F
Credentials:LPC, CRC, MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINCKNEY COLONY RD
Mailing Address - Street 2:OKATIE BUILDING
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4126
Mailing Address - Country:US
Mailing Address - Phone:843-298-2525
Mailing Address - Fax:
Practice Address - Street 1:10 PINCKNEY COLONY RD
Practice Address - Street 2:OKATIE BUILDING
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-4126
Practice Address - Country:US
Practice Address - Phone:843-298-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional