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Individual

DR. JACQUELINE JUANITA MADISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMIN,MA, CAPS, LPC

Contact information

Practice address
5655 KINGSBURY AVE APT 909, SAINT LOUIS, MO 63112-1874
(314) 740-0903
Mailing address
5343 BELLEVILLE CROSSING ST # 2079, BELLEVILLE, IL 62226-3108
(314) 740-0903
(314) 448-1481

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
178.012744
IL
101YP1600X
Pastoral Counselor
Primary
IL
101YP1600X
Pastoral Counselor
171400000X
Health & Wellness Coach
1090
171400000X
Health & Wellness Coach

Other

Enumeration date
01/25/2017
Last updated
05/22/2023
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