Provider Demographics
NPI:1528292810
Name:HEDGECOCK, REBECCA JANE (MA, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JANE
Last Name:HEDGECOCK
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2709
Mailing Address - Country:US
Mailing Address - Phone:910-987-6491
Mailing Address - Fax:910-363-4075
Practice Address - Street 1:103 E 8TH ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3523
Practice Address - Country:US
Practice Address - Phone:910-987-6491
Practice Address - Fax:910-363-4075
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35323101YP2500X
NC7086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104503Medicaid