Provider Demographics
NPI:1730123449
Name:HARDIN, JAMES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EXECUTIVE PL STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5391
Mailing Address - Country:US
Mailing Address - Phone:910-484-4776
Mailing Address - Fax:
Practice Address - Street 1:501 EXECUTIVE PL STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5391
Practice Address - Country:US
Practice Address - Phone:910-484-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015J8OtherBLUECROSS BLUESHIELD GROUP
NC130069OtherMANAGED HEALTH NETWORK
188989OtherCOMPSYCH
NC6001213Medicaid
NC1585WOtherBLUECROSS BLUESHIELD
NC2826055Medicare PIN