Provider Demographics
NPI:1811927973
Name:HARDIN, GLORIA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:E
Last Name:HARDIN
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 1:840 PINEHURST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-750-0251
Mailing Address - Fax:
Practice Address - Street 1:840 PINEHURST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1739
Practice Address - Country:US
Practice Address - Phone:601-750-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC03421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113009Medicaid
MS00113009Medicaid
MS302I805886Medicare PIN
MSR76988Medicare UPIN
MS512I800003Medicare PIN