Provider Demographics
NPI:1831066687
Name:MADDOX, KATHY LYNETTE (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNETTE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 BLACK OAK CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9216
Mailing Address - Country:US
Mailing Address - Phone:706-373-7307
Mailing Address - Fax:
Practice Address - Street 1:4243 BLACK OAK CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9216
Practice Address - Country:US
Practice Address - Phone:706-373-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty