Provider Demographics
NPI:1467835819
Name:MADDOCKS, GEORGE (LPC, NBCC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:MADDOCKS
Suffix:
Gender:M
Credentials:LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8752 QUARTERS LAKE RD
Mailing Address - Street 2:BLDG 9
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7306
Mailing Address - Country:US
Mailing Address - Phone:225-922-9122
Mailing Address - Fax:225-922-9125
Practice Address - Street 1:8752 QUARTERS LAKE RD
Practice Address - Street 2:BLDG 9
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7306
Practice Address - Country:US
Practice Address - Phone:225-922-9122
Practice Address - Fax:225-922-9125
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1816101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13971463OtherCAQH