Provider Demographics
NPI:1306195763
Name:HARDIN, JENNIFER DAWN (RN, LGSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RN, LGSW
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 718
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-0718
Mailing Address - Country:US
Mailing Address - Phone:410-758-2211
Mailing Address - Fax:410-758-1223
Practice Address - Street 1:120 BANJO LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1002
Practice Address - Country:US
Practice Address - Phone:410-758-2211
Practice Address - Fax:410-758-1223
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker