Individual
NICOLE S MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
505 28TH ST, VIENNA, WV 26105-1451
(304) 295-4484
Mailing address
505 28TH ST, VIENNA, WV 26105-1451
(304) 295-4484
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12-305
WV
101YP2500X
Professional Counselor
Primary
2069
WV
Other
Enumeration date
01/15/2014
Last updated
02/08/2019
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