Provider Demographics
NPI:1316529134
Name:HARDIN, SHAMEKA ANN (CSW)
Entity type:Individual
Prefix:MRS
First Name:SHAMEKA
Middle Name:ANN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:SHAMEKA
Other - Middle Name:
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CATLETT CT
Mailing Address - Street 2:
Mailing Address - City:RINEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40162-9407
Mailing Address - Country:US
Mailing Address - Phone:270-945-3559
Mailing Address - Fax:
Practice Address - Street 1:6000 S WOODLAND DR
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-8761
Practice Address - Country:US
Practice Address - Phone:270-352-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2526761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical