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Individual

AMANDA MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
762 CYPRESS ST, SAN DIMAS, CA 91773
(909) 599-1227
Mailing address
762 CYPRESS ST # 107, SAN DIMAS, CA 91773-3505
(909) 599-1227
(702) 944-7846

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
89378
CA
1041C0700X
Clinical Social Worker
Primary
111168
CA
225C00000X
Rehabilitation Counselor

Other

Enumeration date
10/19/2015
Last updated
01/09/2023
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