Provider Demographics
NPI:1063736106
Name:BADGETT, JOSEPH GORDON (LPCA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GORDON
Last Name:BADGETT
Suffix:
Gender:M
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:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2023
Mailing Address - Country:US
Mailing Address - Phone:336-226-3225
Mailing Address - Fax:336-226-3225
Practice Address - Street 1:408 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3848
Practice Address - Country:US
Practice Address - Phone:336-226-3225
Practice Address - Fax:336-226-3225
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health