Provider Demographics
NPI:1841769569
Name:MADDOX, SHERRY DAWN (LPCC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DAWN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 KY HIGHWAY 1778
Mailing Address - Street 2:
Mailing Address - City:HUSTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40437-8986
Mailing Address - Country:US
Mailing Address - Phone:606-787-0424
Mailing Address - Fax:
Practice Address - Street 1:3540 S HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3124
Practice Address - Country:US
Practice Address - Phone:606-679-1815
Practice Address - Fax:606-451-1631
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health