Provider Demographics
NPI:1790889475
Name:GOOD MADDOX, NANCY DEANE (MA LSPE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DEANE
Last Name:GOOD MADDOX
Suffix:
Gender:F
Credentials:MA LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-1604
Mailing Address - Country:US
Mailing Address - Phone:423-626-6352
Mailing Address - Fax:
Practice Address - Street 1:6144 CUMBERLAND GAP PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752
Practice Address - Country:US
Practice Address - Phone:423-626-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSPE 1475103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service