Provider Demographics
NPI:1821113143
Name:HADDOCK, ROY JAMES JR (MA, LPA)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:JAMES
Last Name:HADDOCK
Suffix:JR
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7039
Mailing Address - Country:US
Mailing Address - Phone:910-624-3094
Mailing Address - Fax:
Practice Address - Street 1:559 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5194
Practice Address - Country:US
Practice Address - Phone:910-624-3094
Practice Address - Fax:910-323-4746
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1735103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling