Individual
MR. MARTY DEWAYNE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., CCAADC
Contact information
Practice address
214 PROSPERITY CHURCH RD, BAINBRIDGE, GA 39817-8278
(229) 220-2275
Mailing address
214 PROSPERITY CHURCH RD, BAINBRIDGE, GA 39817-8278
(229) 220-2275
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0115
GA
101YP1600X
Pastoral Counselor
Primary
10114352
GA
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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