Individual
MARTIN DANIEL GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
404 SYCAMORE RD, PORTSMOUTH, VA 23707-1219
(252) 679-8084
Mailing address
404 SYCAMORE RD, PORTSMOUTH, VA 23707-1219
(252) 679-8084
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
03/03/2025
Last updated
06/08/2025
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