Provider Demographics
NPI:1629710637
Name:HARDIN, ROBIN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:HARDIN
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:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-0007
Mailing Address - Country:US
Mailing Address - Phone:770-882-5884
Mailing Address - Fax:706-658-0116
Practice Address - Street 1:4073 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-2305
Practice Address - Country:US
Practice Address - Phone:770-882-5884
Practice Address - Fax:706-658-0116
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist