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General NPI Number Information
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NPI Number | 1770948572
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Entity Type | Individual
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Provider Name | PAMELA MARTIN
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Gender | Female
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 1 WOODBINE AVE NW
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City | ROME
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State | GA
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Zip | 30165-2397
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Country | US
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Telephone | 706-936-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 233 ASHLAND PARK BLVD NE
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City | ROME
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State | GA
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Zip | 30161-8695
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Country | US
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Telephone | 706-844-2540
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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