Provider Demographics
NPI:1255736617
Name:HARDEMAN, CHRISTI PERRY (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:PERRY
Last Name:HARDEMAN
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 1:160 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6263
Mailing Address - Country:US
Mailing Address - Phone:678-596-9477
Mailing Address - Fax:
Practice Address - Street 1:160 MEMORY LN
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6263
Practice Address - Country:US
Practice Address - Phone:678-596-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154573AMedicaid
GA003154573AMedicaid