Provider Demographics
NPI:1104638345
Name:HADORN, DAMIN JON (PSYD)
Entity type:Individual
Prefix:
First Name:DAMIN
Middle Name:JON
Last Name:HADORN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 GENEVA CREST DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3293
Mailing Address - Country:US
Mailing Address - Phone:715-450-0119
Mailing Address - Fax:
Practice Address - Street 1:406 GENEVA CREST DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3293
Practice Address - Country:US
Practice Address - Phone:715-450-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0810008453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical