Provider Demographics
NPI:1932810876
Name:DIFF3R3NT MENTALITY, LLC
Entity Type:Organization
Organization Name:DIFF3R3NT MENTALITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASPEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDGES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-300-3704
Mailing Address - Street 1:27 TERRACE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7335
Mailing Address - Country:US
Mailing Address - Phone:601-248-5115
Mailing Address - Fax:
Practice Address - Street 1:1415 CORPORATE SQUARE DR STE A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3151
Practice Address - Country:US
Practice Address - Phone:601-300-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty