Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 6301009487 | MI |
N | 103K00000X | Behavior Analyst | 6301009487 | |
N | 102L00000X | Psychologist | 6301009487 | MI |
N | 103T00000X | Psychologist | 6301009487 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301009487 | MI |
N | 103TA0700X | Adult Development & Aging Psychologist | 6301009487 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301009487 | MI |
Y | 103G00000X | Clinical Psychologist | 6301009487 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301009487 | MI |
N | 103TC1900X | Counseling Psychologist | 6301009487 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301009487 | MI |
N | 103TE1100X | Exercise & Sports Psychologist | 6301009487 | MI |
N | 103TF0000X | Family Psychologist | 6301009487 | MI |
N | 103TF0200X | Forensic Psychologist | 6301009487 | MI |
N | 103TP0814X | Psychoanalysis | 6301009487 | MI |
N | 103TP2701X | Group Psychotherapist | 6301009487 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301009487 | MI |
NPI | 1497269609 |
---|---|
Provider Name | David Mark Madison |
First Address | Detroit, MI 48228-3361 |
Second Address | Detroit, MI 48228-3361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2017 |
Last Update Date | 01/10/2021 |