Provider Demographics
NPI:1932566049
Name:AMANDA HARDWICK, LCSW, PLLC
Entity Type:Organization
Organization Name:AMANDA HARDWICK, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-260-3445
Mailing Address - Street 1:325 N FRANKLIN ST
Mailing Address - Street 2:H
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2986
Mailing Address - Country:US
Mailing Address - Phone:540-260-3445
Mailing Address - Fax:540-260-9071
Practice Address - Street 1:325 N FRANKLIN ST
Practice Address - Street 2:H
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2986
Practice Address - Country:US
Practice Address - Phone:540-260-3445
Practice Address - Fax:540-260-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601077182Medicaid
VAF511OtherMEDICARE PTAN