Provider Demographics
NPI:1891823738
Name:HARDIE, KATHLEEN NEWSOM (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NEWSOM
Last Name:HARDIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 OLD ASHLAND CITY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-553-8500
Mailing Address - Fax:931-553-8544
Practice Address - Street 1:2141 OLD ASHLAND CITY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-553-8500
Practice Address - Fax:931-553-8544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3921997Medicaid
TN3928973Medicaid
TN3921997Medicaid
TN39259701Medicare PIN