Individual
EBBIE LARHONDA MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 209-4348
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 209-4348
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M9405
MS
Other
Enumeration date
04/02/2019
Last updated
04/02/2019
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