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General NPI Number Information
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NPI Number | 1790664456
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Entity Type | Individual
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Provider Name | MR. EDDIE MARTIN JR.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 7130 MINSTREL WAY STE 125
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City | COLUMBIA
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State | MD
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Zip | 21045-5329
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Country | US
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Telephone | 443-927-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 12946 GRIFFIN CIR
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City | CLARKSBURG
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State | MD
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Zip | 20871-9245
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Country | US
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Telephone | 205-454-3654
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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 | 101YP1600X
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Taxonomy Name | Pastoral 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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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