Healthcare Provider Details

I. General information

NPI: 1073443594
Provider Name (Legal Business Name): RICARDO MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 BILLY ST
PHENIX CITY AL
36869-7542
US

IV. Provider business mailing address

902 BILLY ST
PHENIX CITY AL
36869-7542
US

V. Phone/Fax

Practice location:
  • Phone: 334-559-6323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009001
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC009001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: