Healthcare Provider Details

I. General information

NPI: 1467360982
Provider Name (Legal Business Name): REBECCA HAMM MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA MARTIN LLMSW

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 FULTON ST E STE 204
ADA MI
49301-9086
US

IV. Provider business mailing address

777 DOGWOOD AVE NE
ADA MI
49301-9037
US

V. Phone/Fax

Practice location:
  • Phone: 616-450-3089
  • Fax:
Mailing address:
  • Phone: 616-450-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6851122304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: