Individual
BRIAN DEWAYNE HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLBSW
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 396-5300
Mailing address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 287-6682
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
680288115
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171M0000X
CARE COORDINATOR
MI
Enumeration date
08/27/2014
Last updated
08/27/2014
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