Healthcare Provider Details

I. General information

NPI: 1104214824
Provider Name (Legal Business Name): JENNIFER DAWN MARTIN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 RIVERSIDE DR STE 218
COLUMBUS OH
43221-2579
US

IV. Provider business mailing address

3040 RIVERSIDE DR STE 218
COLUMBUS OH
43221-2579
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-0334
  • Fax: 614-548-8663
Mailing address:
  • Phone: 614-636-0334
  • Fax: 614-548-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE. 1200549
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE. 1200549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: