Provider Demographics
NPI:1902428618
Name:HARDIN, MELISSA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 AQUARIUS DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6127
Mailing Address - Country:US
Mailing Address - Phone:575-760-4503
Mailing Address - Fax:
Practice Address - Street 1:1120 AQUARIUS DR
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6127
Practice Address - Country:US
Practice Address - Phone:575-760-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-111911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical