Provider Demographics
NPI:1073081667
Name:MARTIN, JENNIFER BONNIE (BS-CIT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BONNIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS-CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:607 RUSSELL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7690
Mailing Address - Country:US
Mailing Address - Phone:478-225-9860
Mailing Address - Fax:478-225-9861
Practice Address - Street 1:607 RUSSELL PKWY STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7690
Practice Address - Country:US
Practice Address - Phone:478-225-9860
Practice Address - Fax:478-225-9861
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)