Healthcare Provider Details

I. General information

NPI: 1124401971
Provider Name (Legal Business Name): MADISON CHRISTINE MA IN COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST SUITE E-2
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST SUITE E-2
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8225
  • Fax:
Mailing address:
  • Phone: 505-983-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: