Provider Demographics
NPI:1942456264
Name:HEDGE, KIMBERLY G (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:HEDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 LAKE VIEW DR E
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6909
Mailing Address - Country:US
Mailing Address - Phone:910-818-4132
Mailing Address - Fax:
Practice Address - Street 1:150 W VERMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4823
Practice Address - Country:US
Practice Address - Phone:910-818-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007163Medicaid
NC6007163Medicaid