Healthcare Provider Details

I. General information

NPI: 1689371528
Provider Name (Legal Business Name): MADISON MCDANIEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 UNIVERSITY EXEC PARK DR #665
CHARLOTTE NC
28262-1301
US

IV. Provider business mailing address

207 S BROAD STREET STE 1
MOORESVILLE NC
28115-3189
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-6854
  • Fax: 704-662-0866
Mailing address:
  • Phone: 704-660-6854
  • Fax: 704-662-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018576
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019991
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: