Healthcare Provider Details

I. General information

NPI: 1346519857
Provider Name (Legal Business Name): LESLIE L MADOX CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OLD LANDING RD
MILLSBORO DE
19966
US

IV. Provider business mailing address

220 E MAIN ST A
SALISBURY MD
21801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-1920
  • Fax:
Mailing address:
  • Phone: 410-860-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1678
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: