Healthcare Provider Details

I. General information

NPI: 1508350547
Provider Name (Legal Business Name): JOHN MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WARWOOD AVE
WHEELING WV
26003-7103
US

IV. Provider business mailing address

2011 WARWOOD AVE
WHEELING WV
26003-7103
US

V. Phone/Fax

Practice location:
  • Phone: 304-905-6949
  • Fax: 304-905-6963
Mailing address:
  • Phone: 304-905-6949
  • Fax: 304-905-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.2400453
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: