Provider Demographics
NPI:1457987943
Name:HUERKAMP, MADELINE SMITH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:SMITH
Last Name:HUERKAMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:DESLONDE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APC
Mailing Address - Street 1:1838 INDEPENDENCE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5167
Mailing Address - Country:US
Mailing Address - Phone:205-206-9492
Mailing Address - Fax:
Practice Address - Street 1:1838 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5167
Practice Address - Country:US
Practice Address - Phone:205-206-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC013657101YP2500X
GAAPC007223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health