Provider Demographics
NPI:1093014292
Name:MARTIN, EDWARD T (LPC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CALICO LN
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8705
Mailing Address - Country:US
Mailing Address - Phone:828-564-1282
Mailing Address - Fax:
Practice Address - Street 1:563 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3817
Practice Address - Country:US
Practice Address - Phone:828-564-1282
Practice Address - Fax:828-564-1282
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional