Provider Demographics
NPI:1043719578
Name:MARTIN, MALKEMA TOURE'
Entity Type:Individual
Prefix:
First Name:MALKEMA
Middle Name:TOURE'
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 N TALMAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4009
Mailing Address - Country:US
Mailing Address - Phone:773-668-7729
Mailing Address - Fax:
Practice Address - Street 1:1049 POWERS FERRY RD SE APT 308
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5820
Practice Address - Country:US
Practice Address - Phone:224-307-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional