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NPI Code Detail

MEDICARE: STEPHENIE ANN MARTIN B.S.

MEDICARE: STEPHENIE ANN MARTIN B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1003369208
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHENIE ANN MARTIN B.S.
Provider Business Mailing Address
First Line : 200 TECH CENTER DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37912-2747
Country : US
Telephone Number : 865-637-9711
Fax Number :
Provider Business Practice Location Address
First Line : 1704 E BROADWAY AVE
Second Line :
City : MARYVILLE
State : TN
Zip : 37804-2916
Country : US
Telephone Number : 865-681-6990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2016
Last Update Date : 08/27/2024

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Directions to “ STEPHENIE ANN MARTIN B.S.” Practice Location

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