Provider Demographics
NPI:1316333529
Name:HEDIN, JOANNA (LISW-CP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:HEDIN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NEXTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7915
Mailing Address - Country:US
Mailing Address - Phone:352-459-5019
Mailing Address - Fax:352-388-2280
Practice Address - Street 1:5405 DIPLOMAT CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5620
Practice Address - Country:US
Practice Address - Phone:352-459-5019
Practice Address - Fax:352-388-2280
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122581041C0700X, 1041C0700X
ID104100000X
ND56181041C0700X
OHI.18011471041C0700X
VAPPS-06039321041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1316333529OtherNPI
FL1316333529OtherNPI
OH1316333529OtherNPI