Healthcare Provider Details

I. General information

NPI: 1346144078
Provider Name (Legal Business Name): OLIVIA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 D ST
SAN RAFAEL CA
94901-2814
US

IV. Provider business mailing address

751 E BLITHEDALE PO BOX 78738
MILL VALLEY CA
94941
US

V. Phone/Fax

Practice location:
  • Phone: 415-745-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number165347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: