Provider Demographics
NPI:1073028205
Name:HARDY, MARCIA (MHP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W VINE ST STE C
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-3337
Mailing Address - Country:US
Mailing Address - Phone:337-678-3201
Mailing Address - Fax:
Practice Address - Street 1:1211 W VINE ST STE C
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-3337
Practice Address - Country:US
Practice Address - Phone:337-678-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty