Provider Demographics
NPI:1497126916
Name:MADDOX, DARNELL
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARNELL
Other - Middle Name:M
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:2150 GENERAL PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5125
Mailing Address - Country:US
Mailing Address - Phone:985-635-9225
Mailing Address - Fax:985-674-5155
Practice Address - Street 1:2150 GENERAL PERSHING ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5125
Practice Address - Country:US
Practice Address - Phone:985-674-5155
Practice Address - Fax:985-674-5156
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA#12514104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker