Provider Demographics
NPI:1881031748
Name:MADDOX, LAKIN R (LPC)
Entity Type:Individual
Prefix:
First Name:LAKIN
Middle Name:R
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAKIN
Other - Middle Name:
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 S ROGERS ST STE I
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4331
Mailing Address - Country:US
Mailing Address - Phone:479-335-5747
Mailing Address - Fax:479-957-9083
Practice Address - Street 1:910 S ROGERS ST STE I
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4331
Practice Address - Country:US
Practice Address - Phone:479-335-5747
Practice Address - Fax:479-957-9083
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2402009101YP2500X
ARA2201014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional