MEDICARE: MR. ROBERT JAN HEDGEPATH LCSW, LCAS, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	098	NC
2	1041C0700X	Clinical Social Worker	1801	NC

General Provider Information

NPI Number	:	1104033406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAN HEDGEPATH LCSW, LCAS, CCS

Provider Business Mailing Address
First Line	:	4308 NEW BRIGHTON DR
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-8624
Country	:	US
Telephone Number	:	919-788-8002
Fax Number	:	919-788-0740

Provider Business Practice Location Address
First Line	:	4010 BARRETT DR
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27609-6622
Country	:	US
Telephone Number	:	919-788-8002
Fax Number	:	919-788-0740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/11/2025

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