| NPI | 1942292636 |
|---|---|
| Former Name | MARILYN MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IA ACADC97038) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA LMHC00258) |
| 101YM0800X Counselor Mental Health (Licence: IA LMHP1648) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2007-07-08 |