Provider Demographics
NPI:1851751044
Name:HODGSON, KRISTIN KEAGY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KEAGY
Last Name:HODGSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANN
Other - Last Name:KEAGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:8115 HAWK CREST CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-9530
Mailing Address - Country:US
Mailing Address - Phone:919-619-3939
Mailing Address - Fax:919-619-3939
Practice Address - Street 1:8115 HAWK CREST CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-9530
Practice Address - Country:US
Practice Address - Phone:919-619-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3446103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service