Provider Demographics
NPI:1437374535
Name:HARDY, ANGELA K (LAPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:HARDY
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-4823
Mailing Address - Country:US
Mailing Address - Phone:770-358-8326
Mailing Address - Fax:770-775-1154
Practice Address - Street 1:463 ERNEST BILES DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2229
Practice Address - Country:US
Practice Address - Phone:770-358-8326
Practice Address - Fax:770-775-1154
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional