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NPI Code Detail

MEDICARE: CHRISTINA MARTIN LPC

MEDICARE: CHRISTINA MARTIN LPC
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
1101Y00000XCounselorLPC007593GA
2101YM0800XMental Health CounselorMH13369FL

General Provider Information

NPI Number : 1770914921
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARTIN LPC
Provider Business Mailing Address
First Line : 6767 N WICKHAM RD STE 306
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2025
Country : US
Telephone Number : 321-751-1925
Fax Number : 321-751-9261
Provider Business Practice Location Address
First Line : 6767 N WICKHAM RD STE 306
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2025
Country : US
Telephone Number : 321-751-1925
Fax Number : 321-751-9261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 07/26/2022

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Directions to “ CHRISTINA MARTIN LPC” Practice Location

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