Provider Demographics
NPI:1497920763
Name:HART, ROLAND C (LLP)
Entity Type:Individual
Prefix:
First Name:ROLAND C
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 S WAVERLY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8103
Mailing Address - Country:US
Mailing Address - Phone:616-834-1873
Mailing Address - Fax:616-834-1873
Practice Address - Street 1:348 S WAVERLY RD STE 101
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-8103
Practice Address - Country:US
Practice Address - Phone:616-834-1873
Practice Address - Fax:616-369-1300
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist