MEDICARE: ALEXANDRIA HARDISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-69085	NC

General Provider Information

NPI Number	:	1790237790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA HARDISON

Provider Business Mailing Address
First Line	:	402 CALVIN LN APT 1310
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-0064
Country	:	US
Telephone Number	:	252-809-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 MASONBORO LOOP RD UNIT 150
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-2970
Country	:	US
Telephone Number	:	910-599-2230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	01/09/2026

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