Basic Information
| Provider Information | |||||||||
| NPI: | 1437754819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIATT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 FIELDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483091639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484081727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11111 HALL RD | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483175711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869973153 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2020 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401018793 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.