Individual
BENJAMIN MADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1117 N JACKSON ST, BLOOMINGTON, IN 47404-3385
(812) 322-2817
Mailing address
800 N SMITH RD APT 7B, BLOOMINGTON, IN 47408-2934
(812) 322-2817
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/22/2023
Last updated
02/22/2023
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