MEDICARE: MS. GINETTA MARIE HARDY LLPC

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	101YP2500X	Professional Counselor	6401013366	MI

General Provider Information

NPI Number	:	1528312667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINETTA MARIE HARDY LLPC

Provider Business Mailing Address
First Line	:	16747 ENGLISH GARDEN DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-1199
Country	:	US
Telephone Number	:	586-610-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	28303 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3040
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:

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

Provider Enumeration Date	:	10/27/2012
Last Update Date	:	10/27/2012

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