Provider Demographics
NPI:1053929554
Name:DE VOS, MADELINE (LCSWA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:DE VOS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 HIGHWAY 601 STE 500
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-9537
Mailing Address - Country:US
Mailing Address - Phone:252-287-8620
Mailing Address - Fax:
Practice Address - Street 1:12925 HIGHWAY 601 STE 500
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-9537
Practice Address - Country:US
Practice Address - Phone:252-287-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0189411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical