Provider Demographics
NPI:1194435776
Name:JOHNSON-HEDGEPETH, PAULETTE RENEE (LCSWA)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:RENEE
Last Name:JOHNSON-HEDGEPETH
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-8838
Mailing Address - Country:US
Mailing Address - Phone:252-955-6129
Mailing Address - Fax:
Practice Address - Street 1:2064 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-9436
Practice Address - Country:US
Practice Address - Phone:252-536-5000
Practice Address - Fax:252-536-2258
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical