Healthcare Provider Details

I. General information

NPI: 1841769569
Provider Name (Legal Business Name): SHERRY DAWN MADDOX LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S HIGHWAY 27 STE 4
SOMERSET KY
42501-3124
US

IV. Provider business mailing address

4410 KY HIGHWAY 1778
HUSTONVILLE KY
40437-8986
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1815
  • Fax: 606-451-1631
Mailing address:
  • Phone: 606-787-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number245328
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: