| Doctor Name: | MRS. MARTHA LAWSON VAN DAM |
| NPI Number: | 1134537301 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., NCC |
| License Number: | IMH10994 |
| Business Practice Address: | 151 Mary Esther Blvd Suite 507 Mary Esther, FL - 325691972 |
| Business Phone Number: | 8502267419 |
| Business Fax Number: | |
| Mailing Address: | 226 Windward Way, NICEVILLE |
| State: | FL |
| Postal Code: | 325784328 |
| Phone Number: | 8506875105 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2014 |
| NPI Last Update Date: | 07/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH10994 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |