Provider Demographics
NPI:1417365685
Name:HOPSON, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HOPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WHITHORNE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4754
Mailing Address - Country:US
Mailing Address - Phone:540-907-3877
Mailing Address - Fax:
Practice Address - Street 1:1614 NC HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8297
Practice Address - Country:US
Practice Address - Phone:919-575-6103
Practice Address - Fax:919-575-6817
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040085871041C0700X
NCC0089231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical