Provider Demographics
NPI:1902428519
Name:HARTLINE, MICHAELA D (PHD, PLPC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:D
Last Name:HARTLINE
Suffix:
Gender:F
Credentials:PHD, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N SIBLEY ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6950
Mailing Address - Country:US
Mailing Address - Phone:504-722-1562
Mailing Address - Fax:
Practice Address - Street 1:701 PAPWORTH AVE STE 209
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4923
Practice Address - Country:US
Practice Address - Phone:504-722-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLPC6727101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor