Basic Information
| Provider Information | |||||||||
| NPI: | 1205441433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADDIS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 HWY 64 EAST | ||||||||
| Address2: | |||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28906 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 HWY 64 EAST | ||||||||
| Address2: | |||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288370071 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P015098 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | P015098 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.