Provider Demographics
NPI:1033596853
Name:MARTIN, ERIC ALLEN (CADC III, CRM, CPS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALLEN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CADC III, CRM, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 N. VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-231-8164
Mailing Address - Fax:503-232-4318
Practice Address - Street 1:2054 N. VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-231-8164
Practice Address - Fax:503-232-4318
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05-11-97101YA0400X
OR11-CRM-002101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)