Healthcare Provider Details

I. General information

NPI: 1003504846
Provider Name (Legal Business Name): KMHARDYMINDFULNESS.LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 DIAGONAL RD STE 600
ALEXANDRIA VA
22314-2840
US

IV. Provider business mailing address

1800 DIAGONAL RD STE 600
ALEXANDRIA VA
22314-2840
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-0079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLEY MICHELLE HARDY
Title or Position: SINGLE MEMBER OWNER
Credential: LPC, LPCC-S, LCPC
Phone: 440-444-7140