Provider Demographics
NPI:1649982166
Name:NICELY, MADISON LYNN (RBT)
Entity type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:LYNN
Last Name:NICELY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80901
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0901
Mailing Address - Country:US
Mailing Address - Phone:865-253-5518
Mailing Address - Fax:888-808-4249
Practice Address - Street 1:1820 1ST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5756
Practice Address - Country:US
Practice Address - Phone:865-253-5518
Practice Address - Fax:888-808-4249
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician