Healthcare Provider Details

I. General information

NPI: 1841856747
Provider Name (Legal Business Name): MADELINE WILLCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 BEN FRANKLIN BLVD
DURHAM NC
27704-2140
US

IV. Provider business mailing address

3127 STANFORD DR
DURHAM NC
27707-3831
US

V. Phone/Fax

Practice location:
  • Phone: 919-972-7700
  • Fax:
Mailing address:
  • Phone: 512-797-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number59291
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012221
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: