Doctor Name: | DEIRDRE K MARTIN |
NPI Number: | 1164438941 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH 5462 |
Business Practice Address: | 905 E Martin Luther King Jr Dr Suite 290 Tarpon Springs, FL - 346894864 |
Business Phone Number: | 8132520900 |
Business Fax Number: | |
Mailing Address: | 905 E Martin Luther King Jr Dr, Suite 290 TARPON SPRINGS |
State: | FL |
Postal Code: | 346894864 |
Phone Number: | 8132520900 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 5462 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |