Provider Demographics
NPI:1083329627
Name:HARDY, CECILLIA (ALC, MS)
Entity Type:Individual
Prefix:
First Name:CECILLIA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:ALC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2024
Mailing Address - Country:US
Mailing Address - Phone:334-308-2292
Mailing Address - Fax:
Practice Address - Street 1:557 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2024
Practice Address - Country:US
Practice Address - Phone:334-796-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health