Provider Demographics
NPI:1619061959
Name:HOREY, JUDITH ANN (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:HOREY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:HOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, LCAS
Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1104A S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3134
Practice Address - Country:US
Practice Address - Phone:336-242-2450
Practice Address - Fax:336-242-9920
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111925Medicaid