Individual
MR. WYNN LESLIE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSW, CIT
Contact information
Practice address
4150 EARHART BLVD, NEW ORLEANS, LA 70125-1955
(504) 821-7289
(504) 821-7296
Mailing address
4150 EARHART BLVD, NEW ORLEANS, LA 70125-1955
(504) 821-7287
(504) 821-7296
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386916880
—
LA
Enumeration date
05/11/2017
Last updated
05/11/2017
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