Provider Demographics
NPI:1831837871
Name:CHURCH, MADIGAN ALEXIS (CDCA)
Entity type:Individual
Prefix:
First Name:MADIGAN
Middle Name:ALEXIS
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3223
Mailing Address - Country:US
Mailing Address - Phone:937-892-9000
Mailing Address - Fax:
Practice Address - Street 1:9403 KENWOOD RD STE A130
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6880
Practice Address - Country:US
Practice Address - Phone:300-551-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)