Healthcare Provider Details

I. General information

NPI: 1487819835
Provider Name (Legal Business Name): CAROL S. MARTIN C. PSY.D., TH.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 TAYLORSVILLE RD SUITE #107
DAYTON OH
45424-2376
US

IV. Provider business mailing address

6090 WHITE OAK WAY
HUBER HEIGHTS OH
45424-4068
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-7253
  • Fax: 937-275-7254
Mailing address:
  • Phone: 937-275-7253
  • Fax: 937-275-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: