Healthcare Provider Details

I. General information

NPI: 1285647685
Provider Name (Legal Business Name): VIOLET M MARTIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 E M 36 SUITE D
PINCKNEY MI
48169-9348
US

IV. Provider business mailing address

510 NORTH RD
FENTON MI
48430-1841
US

V. Phone/Fax

Practice location:
  • Phone: 734-308-8360
  • Fax: 810-750-9151
Mailing address:
  • Phone: 734-308-8360
  • Fax: 810-750-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801032981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: