Provider Demographics
NPI:1184835829
Name:HARDIMAN, VICKY L (BSW, CAC-R)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:L
Last Name:HARDIMAN
Suffix:
Gender:F
Credentials:BSW, CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 W LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1833
Mailing Address - Country:US
Mailing Address - Phone:248-334-7824
Mailing Address - Fax:248-334-7824
Practice Address - Street 1:32 W TENNYSON AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2668
Practice Address - Country:US
Practice Address - Phone:248-454-0254
Practice Address - Fax:248-454-6557
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)