Provider Demographics
NPI:1053457341
Name:MARTIN, CARLA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JO
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 REGENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5276
Mailing Address - Country:US
Mailing Address - Phone:615-896-9129
Mailing Address - Fax:
Practice Address - Street 1:151 HERITAGE PARK DR
Practice Address - Street 2:SUITE 303
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0505
Practice Address - Country:US
Practice Address - Phone:615-893-9949
Practice Address - Fax:615-893-9927
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical