Provider Information for 1841699196
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KRISTIE MARTIN LCSW
Other Names:Former Name:KRISTIE MIDENCE LCSWSex: Female
NPI: 1841699196
Last Updated: 2020-09-25
Certification Date: 2020-09-24
Certification Date: 2020-09-24
Details
| Name | Value | ||||||||||||||||
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| NPI | 1841699196 | ||||||||||||||||
| Enumeration Date | 2014-08-21 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 4175 S. ALAMO AVE TUCSON, AZ 85707-4405 United States Phone: 520-228-2615 | Fax: | ||||||||||||||||
| Primary Practice Address | 4175 S. ALAMO AVE TUCSON, AZ 85707-4405 United States Phone: 520-228-2615 | Fax: | ||||||||||||||||
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