Provider Demographics
NPI:1982740262
Name:HARDISON, EDWIN COSTIN (LMHC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:COSTIN
Last Name:HARDISON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:
Other - Last Name:HARDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:221 PAULS DR STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3897
Mailing Address - Country:US
Mailing Address - Phone:813-685-2221
Mailing Address - Fax:813-681-2208
Practice Address - Street 1:221 PAULS DR STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3897
Practice Address - Country:US
Practice Address - Phone:813-685-2221
Practice Address - Fax:813-681-2208
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health