Provider Demographics
NPI:1023637782
Name:MADSEN, MICHAEL EARL (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EARL
Last Name:MADSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 PRESTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-8882
Mailing Address - Country:US
Mailing Address - Phone:435-232-0819
Mailing Address - Fax:252-695-6359
Practice Address - Street 1:261 BELVOIR HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8193
Practice Address - Country:US
Practice Address - Phone:252-695-6352
Practice Address - Fax:252-695-6359
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2111106H00000X
NC12130A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist