Provider Demographics
NPI:1699768788
Name:MADDUX, CHERYL HARMON (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:HARMON
Last Name:MADDUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6945
Mailing Address - Country:US
Mailing Address - Phone:910-471-6516
Mailing Address - Fax:
Practice Address - Street 1:1606 PHYSICIANS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7361
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:910-332-1233
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
B0318OtherMEDCOST
0238MOtherBCBS
NC6005107Medicaid
1608Medicare ID - Type Unspecified