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General NPI Number Information
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NPI Number | 1841153897
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Entity Type | Individual
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Provider Name | MADISON CAROLINE BLACK
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Gender | Female
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 110 TRADERS CROSS FL 1
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City | BLUFFTON
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State | SC
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Zip | 29909-4637
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Country | US
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Telephone | 980-285-9748
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Fax |
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Provider Business Mailing Address
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Address Line | 7108 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34997-7462
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Country | US
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Telephone | 980-285-9748
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | SC
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