Healthcare Provider Details

I. General information

NPI: 1669447660
Provider Name (Legal Business Name): LAUREL E MARTIN LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 BRAMBLETON AVE
ROANOKE VA
24018-3437
US

IV. Provider business mailing address

4656 BRAMBLETON AVE
ROANOKE VA
24018-3437
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8043
  • Fax: 540-772-8242
Mailing address:
  • Phone: 540-772-8043
  • Fax: 540-772-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: