Active NPI
Damin Jon Hadorn, PSYD
- Clinical Psychologist
- Fuquay Varina, NC
National Provider Identifier
1104638345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810008453
- Practice address
- 406 Geneva Crest Dr
Fuquay Varina, NC 27526-3293 - Phone
- (715) 450-0119
- NPI assigned
- Jan 24, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810008453 | NC | Primary |
Addresses
Primary practice location
406 Geneva Crest Dr
Fuquay Varina, NC 27526-3293
Mailing address
406 Geneva Crest Dr
Fuquay Varina, NC 27526-3293
Phone (715) 450-0119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810008453 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737676800000",
"number": "1104638345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 GENEVA CREST DR",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275263293",
"telephone_number": "715-450-0119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 GENEVA CREST DR",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275263293",
"telephone_number": "715-450-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADORN",
"first_name": "DAMIN",
"middle_name": "JON",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-24",
"last_updated": "2025-01-24",
"certification_date": "2025-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "0810008453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.