Healthcare Provider Details

I. General information

NPI: 1477969293
Provider Name (Legal Business Name): TISHA NACOLE HARDIN LISW-S, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TISHA NACOLE HARDIN-SPRADLIN

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COOPER RD
WESTERVILLE OH
43081
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD SUITE 500
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 855-950-5035
  • Fax:
Mailing address:
  • Phone: 855-950-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICDC.111052
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1440382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: