Provider Demographics
NPI:1942915434
Name:RICHARDSON, MADISON N
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:N
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1131
Mailing Address - Country:US
Mailing Address - Phone:870-204-6016
Mailing Address - Fax:870-782-2914
Practice Address - Street 1:1003 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2517
Practice Address - Country:US
Practice Address - Phone:870-204-6016
Practice Address - Fax:870-782-2914
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2306005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor