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General NPI Number Information
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NPI Number | 1134537301
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Entity Type | Individual
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Provider Name | MARTHA LAWSON VAN DAM M.S., NCC
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Gender | Female
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 151 MARY ESTHER BLVD SUITE 507
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City | MARY ESTHER
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State | FL
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Zip | 32569-1972
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Country | US
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Telephone | 850-226-7419
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Fax |
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Provider Business Mailing Address
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Address Line | 226 WINDWARD WAY
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City | NICEVILLE
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State | FL
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Zip | 32578-4328
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Country | US
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Telephone | 850-687-5105
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15174
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License Number State | FL
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