Provider Demographics
NPI:1518370394
Name:CODDINGTON, JOANNE LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:LORRAINE
Last Name:CODDINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LORRAINE
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 RAMSEY ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7658
Mailing Address - Country:US
Mailing Address - Phone:910-580-9346
Mailing Address - Fax:
Practice Address - Street 1:901 ARSENAL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5398
Practice Address - Country:US
Practice Address - Phone:910-495-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21904101YA0400X
NCA10816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)