Healthcare Provider Details

I. General information

NPI: 1477944585
Provider Name (Legal Business Name): LACORTNEY MADDOX LISW-CP, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 255
FALLBROOK CA
92088-0255
US

IV. Provider business mailing address

PO BOX 255
FALLBROOK CA
92088-0255
US

V. Phone/Fax

Practice location:
  • Phone: 910-382-3889
  • Fax:
Mailing address:
  • Phone: 910-382-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4862
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: