Provider Information for 1770986416
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DEMETRIA MARTIN LCSW,CTRS,CLC
Sex: Female
NPI: 1770986416
Last Updated: 2020-02-17
Certification Date: 2020-02-17
Certification Date: 2020-02-17
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1770986416 | ||||||||||||||||||||
| Enumeration Date | 2014-10-08 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 600 STRADA CIR STE 220 MANSFIELD, TX 76063-3209 United States Phone: 469-224-7679 | Fax: | ||||||||||||||||||||
| Primary Practice Address | 600 STRADA CIR STE 220 MANSFIELD, TX 76063-3209 United States Phone: 469-224-7679 | Fax: | ||||||||||||||||||||
| Secondary Practice Address(es) | 353 BROOK HOLLOW DR | ||||||||||||||||||||
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