| Doctor Name: | MRS. GRETCHEN MARIE HART |
| NPI Number: | 1164513164 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LLP,LPC, CACI |
| License Number: | 6401003560 |
| Business Practice Address: | 1350 E West Maple Rd Suite 2 Walled Lake, MI - 483903727 |
| Business Phone Number: | 2487706499 |
| Business Fax Number: | 2486244216 |
| Mailing Address: | 1350 E West Maple Rd, Suite 2 WALLED LAKE |
| State: | MI |
| Postal Code: | 483903727 |
| Phone Number: | 2487706499 |
| Fax Number: | 2486244216 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6401003560 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |