Provider Demographics
NPI:1487865705
Name:HARTMAN, VIRGINIA (MA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2615
Mailing Address - Country:US
Mailing Address - Phone:616-402-3910
Mailing Address - Fax:616-842-4837
Practice Address - Street 1:16950 LANDING DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2615
Practice Address - Country:US
Practice Address - Phone:616-402-3910
Practice Address - Fax:616-842-4837
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional