Provider Demographics
NPI:1588039069
Name:HARDY, BRANDON L (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:HARDY
Suffix:
Gender:M
Credentials:LCSW
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 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:067-883-2347
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:247 UNION POINT ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648
Practice Address - Country:US
Practice Address - Phone:706-743-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0063391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW006339OtherLICENSE