Provider Demographics
NPI:1669883799
Name:BELL, MADIE (LCASA)
Entity type:Individual
Prefix:MRS
First Name:MADIE
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MADISON ANN DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-2046
Mailing Address - Country:US
Mailing Address - Phone:252-268-7625
Mailing Address - Fax:
Practice Address - Street 1:110 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2124
Practice Address - Country:US
Practice Address - Phone:919-635-3344
Practice Address - Fax:919-635-3388
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2249A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)