Provider Demographics
NPI:1952604746
Name:HARDEN, DIA (ED S)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:
Last Name:HARDEN
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 W MOREHEAD ST
Mailing Address - Street 2:STE 114
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5205
Mailing Address - Country:US
Mailing Address - Phone:704-334-3170
Mailing Address - Fax:704-334-3181
Practice Address - Street 1:1230 W MOREHEAD ST
Practice Address - Street 2:STE 114
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5205
Practice Address - Country:US
Practice Address - Phone:704-334-3170
Practice Address - Fax:704-334-3181
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional