Provider Demographics
NPI:1013104785
Name:HINCKLEY, MARIA JOAN PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:JOAN PATRICIA
Last Name:HINCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:JOAN PATRICIA
Other - Last Name:VIDAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6602 KNIGHTDALE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6526
Practice Address - Country:US
Practice Address - Phone:919-747-5270
Practice Address - Fax:919-747-5271
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0060941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007017Medicaid