Provider Demographics
NPI:1740359926
Name:HARDISON, ERIC KEITH (LPC, CSAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:KEITH
Last Name:HARDISON
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2307
Mailing Address - Country:US
Mailing Address - Phone:804-832-4409
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD STE 206
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2307
Practice Address - Country:US
Practice Address - Phone:804-832-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102016101YA0400X
TX11875101YA0400X
TX70174101YP2500X
VA0701003908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010236169Medicaid