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General NPI Number Information
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NPI Number | 1669995874
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Entity Type | Individual
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Provider Name | MARIE RACKLEY PADDOCK LPC, NCC, EMDR
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 1186 FAIRVIEW RD N
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City | CHATHAM
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State | VA
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Zip | 24531-3384
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Country | US
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Telephone | 434-770-4326
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Fax | 434-432-4305
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Provider Business Mailing Address
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Address Line | 929 DOUBLE BRIDGE RD
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City | CHATHAM
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State | VA
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Zip | 24531-4391
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Country | US
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Telephone | 434-770-4326
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Fax | 434-432-4305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701007122
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701007122
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License Number State | VA
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