Provider Demographics
NPI:1598209421
Name:HEDGES-HUBERT, BRANDI JILL (LPC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JILL
Last Name:HEDGES-HUBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:JILL
Other - Last Name:BRADSHAW-HEDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 SAILWAY RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-8906
Mailing Address - Country:US
Mailing Address - Phone:336-979-6555
Mailing Address - Fax:
Practice Address - Street 1:159 SAILWAY RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-8906
Practice Address - Country:US
Practice Address - Phone:336-979-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12607101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional