| Doctor Name: | MR. TERRY A. MARTIN |
| NPI Number: | 1669563227 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A., BCBA |
| License Number: | |
| Business Practice Address: | 1761 Dry Fork Rd Dry Fork, VA - 245494553 |
| Business Phone Number: | 4349476859 |
| Business Fax Number: | |
| Mailing Address: | 1761 Dry Fork Rd, DRY FORK |
| State: | VA |
| Postal Code: | 245494553 |
| Phone Number: | 4349476859 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TM1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
| Taxonomy Definition: | |