Healthcare Provider Details

I. General information

NPI: 1013578723
Provider Name (Legal Business Name): SEAN CARLOS HARDING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 MEADOWWOOD CT
FAIRVIEW TN
37062-5157
US

IV. Provider business mailing address

2865 PENNSYLVANIA AVE
WEIRTON WV
26062-3718
US

V. Phone/Fax

Practice location:
  • Phone: 615-437-7677
  • Fax:
Mailing address:
  • Phone: 410-924-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7073
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: