Provider Demographics
NPI:1346218914
Name:HARDWICK, DANIEL ALEXANDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3818
Mailing Address - Country:US
Mailing Address - Phone:423-967-0784
Mailing Address - Fax:
Practice Address - Street 1:112 BEECH ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3638
Practice Address - Country:US
Practice Address - Phone:276-386-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003100103TC0700X
TNP0000002458103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046394Medicaid
VA00X397A01Medicare PIN