=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982416111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTINO HEALTH & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11630 FULTON ST E
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49331-9426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-914-6925
-----------------------------------------------------
Fax | 866-496-2998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11630 FULTON ST E
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49331-9426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-914-6925
-----------------------------------------------------
Fax | 866-496-2998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ERICA DAWN MARTINO
-----------------------------------------------------
Credential | LPC, CFI, CFTS
-----------------------------------------------------
Telephone | 616-914-6925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------