Provider Demographics
NPI:1346320439
Name:HARDISON, HEATHER G (PHD)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:G
Last Name:HARDISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 POPLAR VIEW LN W
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3175
Mailing Address - Country:US
Mailing Address - Phone:901-413-7536
Mailing Address - Fax:901-854-8595
Practice Address - Street 1:311 POPLAR VIEW LN W
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3175
Practice Address - Country:US
Practice Address - Phone:901-413-7536
Practice Address - Fax:901-854-8595
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical