Provider Demographics
NPI:1124006614
Name:HUGHES, DERRANCE WAYNE (MAED NCC LPC)
Entity Type:Individual
Prefix:MR
First Name:DERRANCE
Middle Name:WAYNE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MAED NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8208
Mailing Address - Country:US
Mailing Address - Phone:252-329-8240
Mailing Address - Fax:
Practice Address - Street 1:209 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-1121
Practice Address - Country:US
Practice Address - Phone:252-799-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1315MOtherBLUE CROSS BLUE SHIELD
NC6102060Medicaid