MEDICARE: MR. YVONN MILLAND HARDY

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	101YM0800X	Mental Health Counselor	0734008610	VA

General Provider Information

NPI Number	:	1932889003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YVONN MILLAND HARDY

Provider Business Mailing Address
First Line	:	900 GRANBY ST STE 203
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2567
Country	:	US
Telephone Number	:	757-756-5246
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 GRANBY ST STE 203
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2567
Country	:	US
Telephone Number	:	757-756-5246
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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