Individual
LIZATTE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1228 GARRET AVE, CHURCHTON, MD 20733-9520
(667) 200-6006
Mailing address
1228 GARRET AVE, CHURCHTON, MD 20733-9520
(667) 200-6006
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225C00000X
Rehabilitation Counselor
—
—
251B00000X
Case Management Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/03/2019
Last updated
04/03/2019
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