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General NPI Number Information
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NPI Number | 1265730238
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Entity Type | Individual
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Provider Name | LATASHA MARTIN ED.S, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 136-4 FORUM DRIVE SUITE 170
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-200-2333
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Fax | 803-877-1036
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Provider Business Mailing Address
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Address Line | 136-4 FORUM DRIVE SUITE 170
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-200-2333
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Fax | 803-877-1036
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5243
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License Number State | SC
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