Provider Demographics
NPI:1508885526
Name:HEDGEPETH, CATHY C (MA, LPA, HSP-PA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:C
Last Name:HEDGEPETH
Suffix:
Gender:F
Credentials:MA, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4304
Mailing Address - Country:US
Mailing Address - Phone:919-272-2524
Mailing Address - Fax:919-870-8917
Practice Address - Street 1:109 E OAK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-2845
Practice Address - Country:US
Practice Address - Phone:919-800-1959
Practice Address - Fax:919-885-5709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC647103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107439Medicaid