Provider Demographics
NPI:1336947308
Name:MADDEN, DWANLA SMITH (LICSW)
Entity type:Individual
Prefix:
First Name:DWANLA
Middle Name:SMITH
Last Name:MADDEN
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 24TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1067
Mailing Address - Country:US
Mailing Address - Phone:205-270-0944
Mailing Address - Fax:
Practice Address - Street 1:757 24TH ST NW
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1067
Practice Address - Country:US
Practice Address - Phone:205-270-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6131C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical