Provider Demographics
NPI:1386014967
Name:HEDGE, KAY E (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:E
Last Name:HEDGE
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 BALSAMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3174
Mailing Address - Country:US
Mailing Address - Phone:301-490-0505
Mailing Address - Fax:
Practice Address - Street 1:61 GAMBRILLS RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-3507
Practice Address - Country:US
Practice Address - Phone:410-987-2221
Practice Address - Fax:410-987-1667
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6047101Y00000X
MDLC6407101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral