Provider Demographics
NPI:1558170621
Name:MADDOX, NONYE
Entity type:Individual
Prefix:
First Name:NONYE
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MENTAL HEALTHCARE, INC. GRACEPOINT
Mailing Address - Street 2:5707 N 22ND STREET
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33578
Mailing Address - Country:US
Mailing Address - Phone:813-239-8069
Mailing Address - Fax:813-231-7324
Practice Address - Street 1:MENTAL HEALTHCARE, INC. GRACEPOINT
Practice Address - Street 2:5707 N 22ND STREET
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:813-239-8069
Practice Address - Fax:813-231-7324
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty