Individual
DAVID LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2960 CHARTRES ST, LA SALLE, IL 61301-1097
(815) 224-1610
Mailing address
301 E HOPKINS AVE, GRANVILLE, IL 61326-9616
(815) 224-1610
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
142.020019
IL
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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