Individual
CAROL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
(503) 760-7463
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/06/2007
Last updated
06/22/2023
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