Provider Demographics
NPI:1164513164
Name:HART, GRETCHEN MARIE (MA, LLP,LPC, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MA, LLP,LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 KENICOTT TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9075
Mailing Address - Country:US
Mailing Address - Phone:248-770-6499
Mailing Address - Fax:248-385-2964
Practice Address - Street 1:29335 WALL ST
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3529
Practice Address - Country:US
Practice Address - Phone:248-770-6499
Practice Address - Fax:248-385-2964
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008426103TC0700X
MI6401003560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical