Provider Demographics
NPI:1215678479
Name:HARDIN-INGRAM, STEPHAN (MA, APCC, NCC, CPHT)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:HARDIN-INGRAM
Suffix:
Gender:
Credentials:MA, APCC, NCC, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5998 ALCALA PARK RM 215
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-8001
Mailing Address - Country:US
Mailing Address - Phone:760-450-8731
Mailing Address - Fax:
Practice Address - Street 1:5998 ALCALA PARK RM 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-8001
Practice Address - Country:US
Practice Address - Phone:760-450-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH188802183700000X
CAAPCC14838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183700000XPharmacy Service ProvidersPharmacy Technician