Provider Demographics
NPI:1104516178
Name:ARD, MADISON MARIE (BA, CIT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:ARD
Suffix:
Gender:F
Credentials:BA, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3745
Mailing Address - Country:US
Mailing Address - Phone:337-321-4126
Mailing Address - Fax:
Practice Address - Street 1:222 W SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3745
Practice Address - Country:US
Practice Address - Phone:337-321-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5636101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)