Individual
MARK MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
(540) 512-9775
Mailing address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
(540) 512-9775
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904007708
VA
Other
Enumeration date
09/23/2008
Last updated
03/17/2018
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