Basic Information
| Provider Information | |||||||||
| NPI: | 1073961397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDWELL | ||||||||
| FirstName: | SHAR'RON | ||||||||
| MiddleName: | DENORRIS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 GLENWOOD DR APT K21001 | ||||||||
| Address2: | |||||||||
| City: | WEST MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712915544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185035447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4951 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712036156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183401535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5796 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 5796 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1020986 | 05 | AK | MEDICAID |