Provider Demographics
NPI:1821465477
Name:HART, KRISTEN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 GRAND RIVER RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6541
Mailing Address - Country:US
Mailing Address - Phone:810-225-9550
Mailing Address - Fax:810-225-9579
Practice Address - Street 1:10299 GRAND RIVER RD
Practice Address - Street 2:SUITE P
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6541
Practice Address - Country:US
Practice Address - Phone:810-225-9550
Practice Address - Fax:810-225-9579
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010962031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical