Provider Demographics
NPI:1932406386
Name:HARDIN, MELISSIA SUE (MA)
Entity Type:Individual
Prefix:
First Name:MELISSIA
Middle Name:SUE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 6TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1265
Mailing Address - Country:US
Mailing Address - Phone:304-768-6170
Mailing Address - Fax:304-768-7465
Practice Address - Street 1:312 6TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1265
Practice Address - Country:US
Practice Address - Phone:304-768-6170
Practice Address - Fax:304-768-7465
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical