Healthcare Provider Details

I. General information

NPI: 1346992781
Provider Name (Legal Business Name): MADELENE THOMAS BARBER MC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 IRONGATE SQ
NORTH CHESTERFIELD VA
23234-6081
US

IV. Provider business mailing address

6603 IRONGATE SQ
NORTH CHESTERFIELD VA
23234-6081
US

V. Phone/Fax

Practice location:
  • Phone: 804-743-0960
  • Fax: 804-396-2195
Mailing address:
  • Phone: 804-743-0960
  • Fax: 804-396-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: