Individual
TINA MYREE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S., QMHP
Contact information
Practice address
2708 NE 14TH ST APT 5, POMPANO BEACH, FL 33062-3564
(888) 880-9270
Mailing address
2324 VICTORY BLVD APT F, PORTSMOUTH, VA 23702-2668
(757) 717-3456
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
T62178724
VA
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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