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General NPI Number Information
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NPI Number | 1568263283
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Entity Type | Individual
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Provider Name | MADISON WYATT LCSWA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 231 N SPRING ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2231
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Country | US
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Telephone | 336-848-3780
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Fax |
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Provider Business Mailing Address
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Address Line | 508 W CAMERON AVE
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City | CHAPEL HILL
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State | NC
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Zip | 27516-2711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P022514
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License Number State | NC
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