Provider Demographics
NPI:1467597179
Name:MCCADDEN, THEODORE JR (LCADC, CPP)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:MCCADDEN
Suffix:JR
Gender:M
Credentials:LCADC, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-4090
Mailing Address - Country:US
Mailing Address - Phone:717-993-9391
Mailing Address - Fax:717-993-9391
Practice Address - Street 1:10151 YORK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3314
Practice Address - Country:US
Practice Address - Phone:410-887-7671
Practice Address - Fax:410-887-7602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA410101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor