Provider Demographics
NPI:1689302077
Name:MADDOX COUNSELING, LLC
Entity Type:Organization
Organization Name:MADDOX COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, RPT-S
Authorized Official - Phone:205-378-9455
Mailing Address - Street 1:3552 PELHAM PKWY # 1060
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2012
Mailing Address - Country:US
Mailing Address - Phone:205-378-9455
Mailing Address - Fax:
Practice Address - Street 1:100 CREEKWOOD LN
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-3272
Practice Address - Country:US
Practice Address - Phone:205-378-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)