Provider Demographics
NPI:1336282672
Name:PADDOCK, KATRINA JEAN (MA, LPC, CADC-M)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:JEAN
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:MA, LPC, CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E CASS ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2170
Mailing Address - Country:US
Mailing Address - Phone:231-884-0028
Mailing Address - Fax:231-824-3641
Practice Address - Street 1:302 E CASS ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2170
Practice Address - Country:US
Practice Address - Phone:231-884-0028
Practice Address - Fax:231-824-3641
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012036101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)