Provider Demographics
NPI:1669995874
Name:PADDOCK, MARIE RACKLEY (LPC, NCC, EMDR)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:RACKLEY
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:LPC, NCC, EMDR
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:RACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 DOUBLE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-4391
Mailing Address - Country:US
Mailing Address - Phone:434-770-4326
Mailing Address - Fax:434-432-4305
Practice Address - Street 1:1186 FAIRVIEW RD N
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3384
Practice Address - Country:US
Practice Address - Phone:434-770-4326
Practice Address - Fax:434-432-4305
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007122101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor