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General NPI Number Information
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NPI Number | 1790982056
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Entity Type | Individual
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Provider Name | JOHN AUBREY MARTIN M.A., LPC
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 510 S TORRENCE ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-3160
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Country | US
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Telephone | 704-907-2898
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Fax | 704-377-3182
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Provider Business Mailing Address
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Address Line | 13512 DANSVILLE DR
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City | PINEVILLE
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State | NC
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Zip | 28134-8111
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Country | US
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Telephone | 704-907-2898
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Fax | 704-377-3182
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC #4441
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License Number State | NC
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