Provider Demographics
NPI:1871270421
Name:MADDEN, MICHELLE (MCAP, LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MCAP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 BIANCA DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5701
Mailing Address - Country:US
Mailing Address - Phone:321-432-5887
Mailing Address - Fax:
Practice Address - Street 1:742 BIANCA DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5701
Practice Address - Country:US
Practice Address - Phone:321-432-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0.0100630101YA0400X
FL20026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)