Healthcare Provider Details

I. General information

NPI: 1437630050
Provider Name (Legal Business Name): DIANNE HARTMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40525 KOPPERNICK RD
CANTON MI
48187-4281
US

IV. Provider business mailing address

41304 LEHIGH LN
NORTHVILLE MI
48167-1927
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-9330
  • Fax:
Mailing address:
  • Phone: 248-229-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801062132
License Number StateMI

VIII. Authorized Official

Name: MS. DIANNE B HARTMAN
Title or Position: PSYCHOTHERAPIST
Credential: LMSW
Phone: 248-910-9330