Provider Demographics
NPI:1083996656
Name:MARTIN, MARIA CARMEN (CADC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2580
Mailing Address - Country:US
Mailing Address - Phone:775-738-8004
Mailing Address - Fax:775-738-2625
Practice Address - Street 1:3740 E IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4611
Practice Address - Country:US
Practice Address - Phone:775-738-8004
Practice Address - Fax:775-738-2625
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)