Provider Demographics
NPI:1417043571
Name:HARDIN, BRENDA L (LCSE)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:HARDIN
Suffix:
Gender:F
Credentials:LCSE
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 746720
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6720
Mailing Address - Country:US
Mailing Address - Phone:773-828-0232
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:5926 CRAWFORDSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3722
Practice Address - Country:US
Practice Address - Phone:317-653-2730
Practice Address - Fax:317-321-1935
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid