Healthcare Provider Details

I. General information

NPI: 1306633532
Provider Name (Legal Business Name): MAGDALINE HICKS BRAXTON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 PINEHURST DR
MADISON AL
35758-2029
US

IV. Provider business mailing address

7579 CRESTRIDGE DR
OWENS CROSS ROADS AL
35763-8855
US

V. Phone/Fax

Practice location:
  • Phone: 256-519-5231
  • Fax:
Mailing address:
  • Phone: 205-370-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL733
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: