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General NPI Number Information
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NPI Number | 1750484283
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Entity Type | Individual
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Provider Name | KATHLEEN SUSAN MARTIN
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 N CENTER ST HEGIRA NORTHVILLE COUNSELING CENTER
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City | NORTHVILLE
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State | MI
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Zip | 48167-1469
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Country | US
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Telephone | 248-347-3470
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Fax | 248-347-2242
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Provider Business Mailing Address
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Address Line | 3155 MYDDLETON DR
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City | TROY
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State | MI
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Zip | 48084-1224
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Country | US
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Telephone | 248-280-3940
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401008985
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License Number State | MI
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