Healthcare Provider Details

I. General information

NPI: 1912112483
Provider Name (Legal Business Name): REBECCA ROBERTS MARTIN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TUSCARAWAS ST W SUITE 200
CANTON OH
44702-2018
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-4128
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2400
  • Fax: 330-438-3003
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0002487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: