Individual provider · Type 1 NPI

Anita Johanson Maddox, LCPC

Developmental Therapist · Lake Villa, IL

NPI number 1770623407 Active

Practice location

89 Cedar Ave
Lake Villa, IL 60046-8411

Call (847) 265-7300 Map

Fax (847) 265-7301

Mailing address

PO Box 764
Lake Villa, IL 60046-0764

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500X180004644 (IL)
Developmental Therapist Primary 222Q00000XAM47190798P (IL)

Developmental Therapist: A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Deve…

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About NPI 1770623407

Anita Johanson Maddox, LCPC's National Provider Identifier is 1770623407, issued on Feb 8, 2007. The primary taxonomy on file is Developmental Therapist (222Q00000X), and the practice location is in Lake Villa, IL. The record was last updated on Sep 21, 2010.