Individual
ANITA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
620 S LAUREL ST, PINE BLUFF, AR 71601-4859
(870) 534-4900
(870) 534-4906
Mailing address
930 WINGATE DRIVE, SUITE 3, CONWAY, AR 72034
(870) 514-9140
(888) 965-4376
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
P0307026
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180635526
—
AR
Enumeration date
05/23/2007
Last updated
09/16/2016
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