Provider Demographics
NPI:1235946120
Name:MADISON, VALARIE R
Entity type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:R
Last Name:MADISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VALARIE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 TALL SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3536
Mailing Address - Country:US
Mailing Address - Phone:843-478-9305
Mailing Address - Fax:
Practice Address - Street 1:100 TALL SPRUCE DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3536
Practice Address - Country:US
Practice Address - Phone:843-478-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator