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General NPI Number Information
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NPI Number | 1972084564
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Entity Type | Individual
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Provider Name | MARGARET LANE MARTIN LPC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 499 KEYWOOD CIR
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City | FLOWOOD
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State | MS
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Zip | 39232-3001
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Country | US
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Telephone | 601-718-0328
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Fax |
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Provider Business Mailing Address
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Address Line | 503 OAKLEIGH PL
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City | BRANDON
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State | MS
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Zip | 39047-6297
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Country | US
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Telephone | 601-506-5922
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2301
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License Number State | MS
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