Provider Demographics
NPI:1568351005
Name:COCKRUM, MADISON P (MA,)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:P
Last Name:COCKRUM
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 PATTERSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6455
Mailing Address - Country:US
Mailing Address - Phone:804-372-7463
Mailing Address - Fax:804-442-7111
Practice Address - Street 1:8545 PATTERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-6455
Practice Address - Country:US
Practice Address - Phone:804-372-7463
Practice Address - Fax:804-442-7111
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health