Gretchen Marie Hart, MA, LLP,LPC, CAADC

Individual provider Active NPI Professional Counselor · Wixom, MI

NPI 1164513164 · NPPES record last updated May 3, 2022

Key facts

NPI
1164513164
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
6401003560 (MI)
Practice address
29335 Wall St
Wixom, MI 48393-3529
Phone
(248) 770-6499
Fax
(248) 385-2964
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6401003560MIMDProfessional Counselor
6301008426MIMDClinical Psychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301008426 MI
Professional Counselor 101YP2500X 6401003560 MI Yes

Addresses

Primary practice location

29335 Wall St
Wixom, MI 48393-3529

Mailing address

10708 Kenicott TRL
Brighton, MI 48114-9075
Phone (248) 770-6499

Other providers in Wixom, MI

All providers in Wixom, MI · Professional Counselor in Michigan

Sources for this page

Verify at the official NPI Registry.