Provider Demographics
NPI:1154945889
Name:MASTERS, MADELYNNE (LCPC)
Entity type:Individual
Prefix:
First Name:MADELYNNE
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 ASHBURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1141
Mailing Address - Country:US
Mailing Address - Phone:304-844-7315
Mailing Address - Fax:
Practice Address - Street 1:1516 ASHBURNHAM DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1141
Practice Address - Country:US
Practice Address - Phone:304-844-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGA2444101YA0400X
MDLC9964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)