Provider Demographics
NPI:1225771827
Name:HARDIMAN, KHADIJAH (LPC)
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:
Last Name:HARDIMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CORPORATE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6388
Mailing Address - Country:US
Mailing Address - Phone:770-954-8685
Mailing Address - Fax:
Practice Address - Street 1:250 CORPORATE CENTER CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6388
Practice Address - Country:US
Practice Address - Phone:770-954-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional