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General NPI Number Information
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NPI Number | 1386252591
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Entity Type | Organization
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Legal Business Name | MADISON HASKELL INC.
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 542 WILLIAMSON RD STE 4
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City | MOORESVILLE
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State | NC
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Zip | 28117-9138
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Country | US
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Telephone | 704-962-8919
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Fax |
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Provider Business Mailing Address
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Address Line | 118 FARMERS FOLLY DR
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City | MOORESVILLE
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State | NC
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Zip | 28117-8572
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Country | US
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Telephone | 704-962-8919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADISON HASKELL
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Credential | LMFT
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Telephone | 704-962-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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