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General NPI Number Information
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NPI Number | 1255016689
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Entity Type | Individual
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Provider Name | MIA NICOLE MARTIN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2610 FOUR SEASONS BLVD
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City | GREENSBORO
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State | NC
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Zip | 27407-6025
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Country | US
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Telephone | 336-294-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 2805 DULAIRE RD
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City | GREENSBORO
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State | NC
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Zip | 27407-5943
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Country | US
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Telephone | 336-549-3004
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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