Healthcare Provider Details

I. General information

NPI: 1508885526
Provider Name (Legal Business Name): CATHY C HEDGEPETH MA, LPA, HSP-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E OAK ST
SELMA NC
27576-2845
US

IV. Provider business mailing address

280 W MILLBROOK RD
RALEIGH NC
27609-4304
US

V. Phone/Fax

Practice location:
  • Phone: 919-800-1959
  • Fax: 919-885-5709
Mailing address:
  • Phone: 919-272-2524
  • Fax: 919-870-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: