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General NPI Number Information
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NPI Number | 1558881128
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Entity Type | Organization
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Legal Business Name | MADISON ENTERPRISES INC
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 114 N MAIN ST STE 102A
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City | SUFFOLK
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State | VA
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Zip | 23434-4564
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Country | US
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Telephone | 757-921-2762
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Fax | 757-257-1011
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Provider Business Mailing Address
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Address Line | 114 N MAIN ST STE 102A
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City | SUFFOLK
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State | VA
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Zip | 23434-4564
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Country | US
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Telephone | 757-921-2762
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Fax | 757-257-1011
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ANGELLO MADISON SR.
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Credential | LPC
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Telephone | 757-921-2762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007132
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License Number State | VA
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