Provider Demographics
NPI:1851457857
Name:PEDIGO, THOMAS STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 FOREST HILLS RD SW STE D
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8611
Mailing Address - Country:US
Mailing Address - Phone:252-234-7800
Mailing Address - Fax:252-234-7030
Practice Address - Street 1:2693 FOREST HILLS RD SW STE D
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8611
Practice Address - Country:US
Practice Address - Phone:252-234-7800
Practice Address - Fax:252-234-7030
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106224Medicaid