Provider Demographics
NPI:1447558051
Name:HART, MEGAN (MA LLP CAADC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MA LLP CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9701
Mailing Address - Country:US
Mailing Address - Phone:248-395-6349
Mailing Address - Fax:248-483-7868
Practice Address - Street 1:141 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:MI
Practice Address - Zip Code:49270-9701
Practice Address - Country:US
Practice Address - Phone:248-395-6349
Practice Address - Fax:248-483-7868
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014646103T00000X
MI6361004514103T00000X
MIC-02623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)