Provider Demographics
NPI:1205626587
Name:FOLK, MADELINE (LAC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:FOLK
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:MAGDA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:8911 W MISSION LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7098
Mailing Address - Country:US
Mailing Address - Phone:805-459-3813
Mailing Address - Fax:
Practice Address - Street 1:1904 W PARKSIDE LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1232
Practice Address - Country:US
Practice Address - Phone:480-757-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health