1891195749 NPI number — MRS. JENNIFER BLACK-HARDWICK MS, LPC

Table of content: (NPI 1366807794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891195749 NPI number — MRS. JENNIFER BLACK-HARDWICK MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK-HARDWICK
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891195749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 W TROY ST STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36303-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-231-1241
Provider Business Mailing Address Fax Number:
334-231-1242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 W TROY ST STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-231-1241
Provider Business Practice Location Address Fax Number:
334-231-1242
Provider Enumeration Date:
08/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  3890 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: C2121A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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