# DR. JACQUELINE JUANITA MADISON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972040210
- **Gender:** F
- **Credential:** DMIN,MA, CAPS, LPC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | 178.012744 | IL | — |
| 101YP1600X | Pastoral Counselor | — | IL | Yes |
| 101YP1600X | Pastoral Counselor | — | NULL | — |
| 171400000X | Health & Wellness Coach | 1090 | NULL | — |
| 171400000X | Health & Wellness Coach | 1090 | — | — |

## Other

- **Enumeration date:** 01/25/2017
- **Last updated:** 05/22/2023