Provider Demographics
NPI:1558340729
Name:BREDEHOEFT, KATHERINE R (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:BREDEHOEFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3711
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-3711
Mailing Address - Country:US
Mailing Address - Phone:919-612-5549
Mailing Address - Fax:910-829-9001
Practice Address - Street 1:7404 CHAPEL HILL RD STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5043
Practice Address - Country:US
Practice Address - Phone:919-468-9444
Practice Address - Fax:910-829-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202850OtherCOMPSYCH
NC6000267Medicaid
NCE1468OtherMEDCOST
NC265366OtherMANGED HEALTH NETWORK
NC045M3OtherBLUE CROSS BLUE SHIELD
NC045M3OtherBLUE CROSS BLUE SHIELD