Provider Demographics
NPI:1447023510
Name:SMITH, MADISON TAYLOR (MSW, LISW-CP)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 STUART ENGALS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7312
Mailing Address - Country:US
Mailing Address - Phone:843-459-9805
Mailing Address - Fax:
Practice Address - Street 1:1435 STUART ENGALS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7312
Practice Address - Country:US
Practice Address - Phone:843-459-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12486101YM0800X
SC167791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid