Healthcare Provider Details

I. General information

NPI: 1467186726
Provider Name (Legal Business Name): RICQUE A HARDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 NEW POINTE BLVD STE 19
LELAND NC
28451-4129
US

IV. Provider business mailing address

1608 QUEEN ST STE 1
WILMINGTON NC
28401-5527
US

V. Phone/Fax

Practice location:
  • Phone: 910-253-5885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017593
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: