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General NPI Number Information
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NPI Number | 1528312667
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Entity Type | Individual
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Provider Name | GINETTA MARIE HARDY LLPC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2012
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Last Update Date | 10/27/2012
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Provider Practice Location Address
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Address Line | 28303 DEQUINDRE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3040
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Country | US
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Telephone | 248-543-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 16747 ENGLISH GARDEN DR
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City | MACOMB
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State | MI
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Zip | 48042-1199
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Country | US
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Telephone | 586-610-4343
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013366
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License Number State | MI
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