Provider Demographics
NPI:1386252591
Name:MADISON HASKELL INC.
Entity type:Organization
Organization Name:MADISON HASKELL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:704-962-8919
Mailing Address - Street 1:118 FARMERS FOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8572
Mailing Address - Country:US
Mailing Address - Phone:704-962-8919
Mailing Address - Fax:
Practice Address - Street 1:542 WILLIAMSON RD STE 4
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9138
Practice Address - Country:US
Practice Address - Phone:704-962-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)