Provider Demographics
NPI:1912675208
Name:DE LEON, MADISON NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 JABEZ DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-1129
Mailing Address - Country:US
Mailing Address - Phone:804-239-4374
Mailing Address - Fax:
Practice Address - Street 1:124 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1608
Practice Address - Country:US
Practice Address - Phone:540-459-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040132461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical