Provider Demographics
NPI:1003369208
Name:MARTIN, STEPHENIE ANN (BS)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:STEPHENIE
Other - Middle Name:ANN
Other - Last Name:LANGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:875 WAIMANU ST STE 612
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5267
Mailing Address - Country:US
Mailing Address - Phone:808-791-6713
Mailing Address - Fax:
Practice Address - Street 1:875 WAIMANU ST STE 612
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5267
Practice Address - Country:US
Practice Address - Phone:808-791-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)