Healthcare Provider Details

I. General information

NPI: 1952923633
Provider Name (Legal Business Name): DEBRA L MARTIN CDCA.140459
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 9TH ST STE 1210
CLEVELAND OH
44114-1513
US

IV. Provider business mailing address

2532 E 86TH ST
CLEVELAND OH
44104-2244
US

V. Phone/Fax

Practice location:
  • Phone: 216-867-7930
  • Fax:
Mailing address:
  • Phone: 216-867-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCA.140459
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCDCA.140459
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: