Healthcare Provider Details

I. General information

NPI: 1194280131
Provider Name (Legal Business Name): OLIVIA MADEWELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MAITLAND AVE # 16
ALTAMONTE SPRINGS FL
32701-5444
US

IV. Provider business mailing address

2480 CHERRY LAUREL DR APT 343
SANFORD FL
32771-8859
US

V. Phone/Fax

Practice location:
  • Phone: 321-616-7225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: