Provider Demographics
NPI:1770001034
Name:HADDOCK, REBECCA MADELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MADELINE
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:HADDOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2505 S 17TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7992
Mailing Address - Country:US
Mailing Address - Phone:910-254-4545
Mailing Address - Fax:
Practice Address - Street 1:2505 S 17TH ST STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7992
Practice Address - Country:US
Practice Address - Phone:910-254-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker