Individual
DERRICK E MARTIN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 NE GRAND AVE, PORTLAND, OR 97232
(510) 337-7950
Mailing address
55 NE GRAND AVE, PORTLAND, OR 97232
(510) 337-7950
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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