Provider Demographics
NPI:1457677957
Name:MADDOCK, WIILAM J (CACIII)
Entity Type:Individual
Prefix:
First Name:WIILAM
Middle Name:J
Last Name:MADDOCK
Suffix:
Gender:M
Credentials:CACIII
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:990 BANNOCK ST
Mailing Address - Street 2:MC 7782
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4028
Mailing Address - Country:US
Mailing Address - Phone:303-436-3563
Mailing Address - Fax:303-436-3500
Practice Address - Street 1:990 BANNOCK ST
Practice Address - Street 2:MC 7782
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4028
Practice Address - Country:US
Practice Address - Phone:720-956-2394
Practice Address - Fax:720-956-2533
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COACC-634103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)