Provider Demographics
NPI:1528800992
Name:CARR, MADELINE BROOKE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:BROOKE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DALLAS BESSEMER CITY HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9489
Mailing Address - Country:US
Mailing Address - Phone:704-675-3142
Mailing Address - Fax:
Practice Address - Street 1:910 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3449
Practice Address - Country:US
Practice Address - Phone:704-675-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician