Individual
FREDERICKA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
110 HOWARD LN, ANDERSON, SC 29621-6817
(704) 777-8504
Mailing address
9723 WINGED TRAIL CT, CHARLOTTE, NC 28277-4695
(704) 777-8504
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
47-19724120
SC
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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