Provider Demographics
NPI:1184889263
Name:PADDOCK, NANCY GAIL (LMFT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:GAIL
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 CREIGHTON RD APT 139
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9167
Mailing Address - Country:US
Mailing Address - Phone:850-419-2244
Mailing Address - Fax:850-479-8604
Practice Address - Street 1:6706 N 9TH AVE STE C5
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7379
Practice Address - Country:US
Practice Address - Phone:850-419-2244
Practice Address - Fax:850-479-8604
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2057172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker