Individual
MADISON SPORTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1003 MARY ST, WAYCROSS, GA 31503-3823
(912) 449-7100
Mailing address
1007 MARY ST, WAYCROSS, GA 31503-3823
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/27/2025
Last updated
05/27/2025
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