Healthcare Provider Details

I. General information

NPI: 1003087800
Provider Name (Legal Business Name): MADELINE THOMPSON MA LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 TERRACE DR
HIGHLAND LAKES NJ
07422-1605
US

IV. Provider business mailing address

933 ROUTE 23 SUITE #10
POMPTON PLAINS NJ
07444-1047
US

V. Phone/Fax

Practice location:
  • Phone: 973-764-4872
  • Fax:
Mailing address:
  • Phone: 973-222-6762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number#37LC00133700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number#37LC00133700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: