Provider Demographics
NPI:1578337341
Name:QUINLAN, MADELYN (LCMHC-A)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 FAYETTEVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2146
Mailing Address - Country:US
Mailing Address - Phone:910-536-1719
Mailing Address - Fax:
Practice Address - Street 1:4904 FAYETTEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2146
Practice Address - Country:US
Practice Address - Phone:910-536-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCA18130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA18130OtherSTATE LICENSE