Provider Demographics
NPI:1467663682
Name:EDGERTON, PATRICIA LANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LANE
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-781-2669
Mailing Address - Fax:919-881-0547
Practice Address - Street 1:4601 LAKE BOONE TRL
Practice Address - Street 2:SUITE 3A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-781-2669
Practice Address - Fax:919-881-0547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30090OtherBLUE CROSS ID NUMBER