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General NPI Number Information
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NPI Number | 1053443515
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Entity Type | Individual
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Provider Name | MARTHA JOAN WENT LPC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 BILLINGSLEY RD COTTAGE E - ADULT PARTIAL HOSPITALIZATION
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City | CHARLOTTE
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State | NC
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Zip | 28211-1009
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Country | US
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Telephone | 704-444-2518
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Fax |
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Provider Business Mailing Address
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Address Line | 31007 EXECUTIVE PT
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City | TEGA CAY
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State | SC
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Zip | 29708-8503
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Country | US
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Telephone | 803-802-3670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5050
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4794
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License Number State | SC
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