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Individual
MR. MARTY DEWAYNE BROCK
Active
Individual
MR. MARTY DEWAYNE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., CCAADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0115
GA
101YP1600X
Pastoral Counselor
Primary
10114352
GA
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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