Healthcare Provider Details

I. General information

NPI: 1013185313
Provider Name (Legal Business Name): VICTORIA R MARTIN PCC-S, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

7 SIERRA LN
ARCANUM OH
45304-1361
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax: 937-548-1500
Mailing address:
  • Phone: 937-638-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0027502
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1000082-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: