Individual
MR. MARVIN R MARTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
4 MLS S OF I-40 ON HWY 191, SANDERS, SANDERS, AZ 86512-1086
(928) 688-3475
(928) 688-3478
Mailing address
PO BOX 1086, SANDERS, AZ 86512-1086
(928) 688-3475
(928) 688-3478
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11363
AZ
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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