Provider Demographics
NPI:1487978557
Name:HARDY-GARCIA, MARY ELIZABETH (LPCC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HARDY-GARCIA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12436 STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9705
Mailing Address - Country:US
Mailing Address - Phone:740-577-5289
Mailing Address - Fax:606-932-2453
Practice Address - Street 1:102 BIGGS LN
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-7846
Practice Address - Country:US
Practice Address - Phone:740-577-5289
Practice Address - Fax:606-932-2453
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid