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General NPI Number Information
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NPI Number | 1164513164
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Entity Type | Individual
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Provider Name | GRETCHEN MARIE HART MA, LLP,LPC, CAADC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 29335 WALL ST
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City | WIXOM
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State | MI
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Zip | 48393-3529
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Country | US
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Telephone | 248-770-6499
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Fax | 248-385-2964
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Provider Business Mailing Address
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Address Line | 10708 KENICOTT TRL
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City | BRIGHTON
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State | MI
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Zip | 48114-9075
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Country | US
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Telephone | 248-770-6499
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Fax | 248-385-2964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301008426
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401003560
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License Number State | MI
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