Provider Demographics
NPI:1174287163
Name:HEFLIN, MADISON BENNETT (ALC, NCC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BENNETT
Last Name:HEFLIN
Suffix:
Gender:F
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10874 WAR EMBLEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0708
Mailing Address - Country:US
Mailing Address - Phone:251-275-6366
Mailing Address - Fax:
Practice Address - Street 1:6475 SPANISH FORT BLVD STE E
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-9403
Practice Address - Country:US
Practice Address - Phone:251-225-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3823A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor