Provider Demographics
NPI:1114058500
Name:HUGHES, EDWARD E (LPA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:E
Last Name:HUGHES
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 UNION RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5694
Mailing Address - Country:US
Mailing Address - Phone:704-879-9273
Mailing Address - Fax:562-286-5236
Practice Address - Street 1:1307 UNION RD STE 105
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5694
Practice Address - Country:US
Practice Address - Phone:704-879-9273
Practice Address - Fax:562-286-5236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC1900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107451Medicaid