Healthcare Provider Details

I. General information

NPI: 1174079578
Provider Name (Legal Business Name): JESSICA MARTIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

655 7TH ST
ROBINS AFB GA
31098-2227
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7850
  • Fax:
Mailing address:
  • Phone: 478-327-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20924
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-36731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: