Provider Demographics
NPI:1013185313
Name:MARTIN, VICTORIA R (PCC-S, LSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PCC-S, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SIERRA LN
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-1361
Mailing Address - Country:US
Mailing Address - Phone:937-638-0544
Mailing Address - Fax:
Practice Address - Street 1:212 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1913
Practice Address - Country:US
Practice Address - Phone:937-548-1635
Practice Address - Fax:937-548-1500
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0027502104100000X
OHE1000082-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker