Provider Demographics
NPI:1285078253
Name:HEYDT, BETHANY BALDWIN (LPCA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:BALDWIN
Last Name:HEYDT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 LIVINGSTON DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9517
Mailing Address - Country:US
Mailing Address - Phone:704-783-8641
Mailing Address - Fax:
Practice Address - Street 1:236 LEPHILLIP COURT
Practice Address - Street 2:SUITE NUMBER D
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-786-4503
Practice Address - Fax:704-793-1098
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional