Healthcare Provider Details

I. General information

NPI: 1902094881
Provider Name (Legal Business Name): CAROL ANNE DOUGLASS MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N WAITE ST
MANCHESTER TN
37355-1553
US

IV. Provider business mailing address

102 N WAITE ST
MANCHESTER TN
37355-1553
US

V. Phone/Fax

Practice location:
  • Phone: 931-581-4737
  • Fax:
Mailing address:
  • Phone: 931-581-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5285
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: