Individual
VIVICA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
58 TIMBER CREEK DR, CORDOVA, TN 38018-4233
(901) 673-1600
Mailing address
58 TIMBER CREEK DR, CORDOVA, TN 38018-4233
(901) 673-1571
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/17/2023
Last updated
05/24/2025
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