Provider Demographics
NPI:1972226595
Name:CALLIHAN, MADELYNE (LCMHCA)
Entity type:Individual
Prefix:
First Name:MADELYNE
Middle Name:
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:MADELYNE
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:207 S BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3189
Mailing Address - Country:US
Mailing Address - Phone:704-660-6854
Mailing Address - Fax:704-662-0866
Practice Address - Street 1:207 S BROAD STREET
Practice Address - Street 2:1
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3189
Practice Address - Country:US
Practice Address - Phone:704-660-6854
Practice Address - Fax:704-662-0866
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18082101YM0800X
NCA18082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972226595Medicaid