Provider Demographics
NPI:1124314687
Name:HARDISON, JAMES
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:HARDISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-7268
Mailing Address - Country:US
Mailing Address - Phone:252-946-2324
Mailing Address - Fax:
Practice Address - Street 1:3622 CHERRY RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-7267
Practice Address - Country:US
Practice Address - Phone:252-946-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health