Provider Demographics
NPI:1174150825
Name:LEATHERMAN, MADALYN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BEALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-4944
Mailing Address - Country:US
Mailing Address - Phone:901-651-8914
Mailing Address - Fax:
Practice Address - Street 1:187 BEALLWOOD DR
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:GA
Practice Address - Zip Code:30814-4944
Practice Address - Country:US
Practice Address - Phone:762-233-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist