Provider Demographics
NPI:1780261305
Name:HARDY, TANEKA NICOLE
Entity type:Individual
Prefix:
First Name:TANEKA
Middle Name:NICOLE
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20793 VICTORIA WAY APT 2E
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-6087
Mailing Address - Country:US
Mailing Address - Phone:256-508-5527
Mailing Address - Fax:
Practice Address - Street 1:20793 VICTORIA WAY APT 2E
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-6087
Practice Address - Country:US
Practice Address - Phone:256-508-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4413C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health