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Individual

MARISA DANIELLE MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2070 NORTHBROOK BLVD STE B4, NORTH CHARLESTON, SC 29406-9254
(843) 569-3033
(843) 569-6820
Mailing address
224 SWEET ALYSSUM DR, LADSON, SC 29456-3899
(615) 785-7844

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-83211
TN

Other

Enumeration date
06/30/2022
Last updated
06/30/2022
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