Healthcare Provider Details

I. General information

NPI: 1578381042
Provider Name (Legal Business Name): MADISON CARTER YOUNG CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

30 COURTENAY DRIVE ROOM 113 MSC 592
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-6865
  • Fax:
Mailing address:
  • Phone: 843-792-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: