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General NPI Number Information
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NPI Number | 1114632262
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Entity Type | Individual
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Provider Name | MAKAYLA MARTIN
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Gender | Female
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 100 EMANCIPATION DR
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City | HAMPTON
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State | VA
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Zip | 23667-0001
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Country | US
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Telephone | 757-722-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 445-2 ORIANA RD. PMB1038
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-2319
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Country | US
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Telephone | 757-504-4515
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 14354
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17440
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License Number State | SC
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