Provider Demographics
NPI:1326531245
Name:MADDOX, BRENNA BURNS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:BURNS
Last Name:MADDOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SHADOW RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4316
Mailing Address - Country:US
Mailing Address - Phone:828-337-1013
Mailing Address - Fax:
Practice Address - Street 1:100 RENEE LYNN CT
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6511
Practice Address - Country:US
Practice Address - Phone:919-966-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018306103TC0700X
NC5825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical