Madeline Noel Fults, CIT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Pine Bluff, AR
NPI 1962896217 · NPPES record last updated Mar 25, 2015
Key facts
- NPI
- 1962896217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Practice address
- 2304 W 29TH Ave
Suite 1
Pine Bluff, AR 71603-5005 - Phone
- (870) 247-5222
- Fax
- (870) 671-4847
- NPI assigned
- Mar 25, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Yes |
Addresses
Primary practice location
2304 W 29TH Ave
Suite 1
Pine Bluff, AR 71603-5005
Mailing address
PO Box 21203
White Hall, AR 71612-1203
Phone (870) 247-5222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 206621740 | Medicaid | AR |
Other providers in Pine Bluff, AR
- Shandra Freeman
- Jacquelyn Sue Frigon MD PA
- Ft McDonald DDS LTD
- Dawn Fuller
- Tia Fulton
- Functional Testing Centers, Inc.
- Snigdha Gadireddy
- Ian Trevor Gaillard
- Johnalyn Gallinero
- Galster'S Orthopedic Laboratories, Inc.
All providers in Pine Bluff, AR · Addiction (Substance Use Disorder) Counselor in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.