# MAVERICK ADDICTION SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932409729
- **Authorized official:** MRS. VICKIE J COX L.A.C. NCAC II... (CEO & ADDICTION COUNSELOR)
- **Authorized official phone:** (812) 953-1181

## Contact information

- **Practice address:** 35 S STATE ST, SUITE 1, NORTH VERNON, IN 47265-1800
- **Practice address phone:** (812) 953-1181
- **Practice address fax:** (812) 953-1158
- **Mailing address:** PO BOX 951, 35 S. STATE ST., SUITE 1, NORTH VERNON, IN 47265-0951
- **Mailing address phone:** (812) 953-1181
- **Mailing address fax:** (812) 953-1158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 86000039A | IN | Yes |
| 104100000X | Social Worker | — | IN | — |

## Other

- **Enumeration date:** 10/26/2010
- **Last updated:** 10/26/2010