Provider Demographics
NPI:1982142584
Name:HARDEMAN, D'LISA
Entity Type:Individual
Prefix:
First Name:D'LISA
Middle Name:
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0278
Mailing Address - Country:US
Mailing Address - Phone:817-213-6889
Mailing Address - Fax:
Practice Address - Street 1:601 STRADA CIR STE 109
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3212
Practice Address - Country:US
Practice Address - Phone:817-213-6889
Practice Address - Fax:817-478-6525
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional