Provider Demographics
NPI:1629117981
Name:MADDOX, EMILY JEAN (LPCC #374)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JEAN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LPCC #374
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:JEAN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1359 SCOTT LEE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9155
Mailing Address - Country:US
Mailing Address - Phone:559-362-0676
Mailing Address - Fax:
Practice Address - Street 1:107 NELSON ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3318
Practice Address - Country:US
Practice Address - Phone:805-362-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669559878OtherMEDICAL