Provider Demographics
NPI:1568622256
Name:DART, KATHLEEN CHRISTINE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:CHRISTINE
Last Name:DART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8267
Mailing Address - Country:US
Mailing Address - Phone:517-339-8341
Mailing Address - Fax:
Practice Address - Street 1:4970 NORTHWIND DR STE 209B
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5030
Practice Address - Country:US
Practice Address - Phone:517-285-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical