| NPI | 1558361527 |
|---|---|
| Former Name | SUSAN CAROL MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 403) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 538) |
| 1041C0700X Social Worker, Clinical (Licence: WV CP00452669) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2024-03-04 |