Provider Demographics
NPI:1104033406
Name:HEDGEPATH, ROBERT JAN (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAN
Last Name:HEDGEPATH
Suffix:
Gender:M
Credentials:LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 NEW BRIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-8624
Mailing Address - Country:US
Mailing Address - Phone:919-788-8002
Mailing Address - Fax:919-788-0740
Practice Address - Street 1:4010 BARRETT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6622
Practice Address - Country:US
Practice Address - Phone:919-788-8002
Practice Address - Fax:919-788-0740
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC098101YA0400X
NC18011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical