Healthcare Provider Details

I. General information

NPI: 1306575527
Provider Name (Legal Business Name): MADISON CANTRELL WATKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 CHASE HIGH RD
FOREST CITY NC
28043-5663
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 828-247-1043
  • Fax: 828-247-0551
Mailing address:
  • Phone: 704-730-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: