Doctor Name: | MRS. NICOLE GREGORY MARTIN |
NPI Number: | 1538283031 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 4519 |
Business Practice Address: | 113 E Sothel St Suite 6 Kill Devil Hills, NC - 279486961 |
Business Phone Number: | 2522073701 |
Business Fax Number: | 2524413057 |
Mailing Address: | 300 E Driftwood St, NAGS HEAD |
State: | NC |
Postal Code: | 279599173 |
Phone Number: | 2522073701 |
Fax Number: | 2524413057 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4519 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |