Provider Demographics
NPI:1326728692
Name:EDWARDS, MADALIN (LLC)
Entity type:Individual
Prefix:
First Name:MADALIN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:LLC
Other - Prefix:
Other - First Name:MADALIN
Other - Middle Name:
Other - Last Name:SOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8072 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4310
Mailing Address - Country:US
Mailing Address - Phone:248-469-8454
Mailing Address - Fax:
Practice Address - Street 1:8072 21 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4310
Practice Address - Country:US
Practice Address - Phone:248-469-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023056101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor