Individual
MADISON LEIGH FIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
326 MYRTLE CROSSING DR, STATESBORO, GA 30458-4688
(912) 764-7001
Mailing address
908 TEEPEE WAY, STATESBORO, GA 30461-6786
(912) 536-1682
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
APC009467
GA
101YP2500X
Professional Counselor
Primary
LPC016683
GA
Other
Enumeration date
01/25/2024
Last updated
05/06/2026
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