Provider Demographics
NPI:1285993527
Name:MADDOX, J. SCOTT (MS, LPC, NCAC-II, CC)
Entity type:Individual
Prefix:MR
First Name:J.
Middle Name:SCOTT
Last Name:MADDOX
Suffix:
Gender:M
Credentials:MS, LPC, NCAC-II, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WATER OAK PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8382
Mailing Address - Country:US
Mailing Address - Phone:404-226-4536
Mailing Address - Fax:
Practice Address - Street 1:848 HIRAM ACWORTH HWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6010
Practice Address - Country:US
Practice Address - Phone:770-222-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACAC-II 1908101YA0400X
GANCAC-II 014815101YA0400X
GALPC006429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)