Provider Demographics
NPI:1104359801
Name:MARTIN, GINA J (LPC-S)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 VIOLA FARMS DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-3102
Mailing Address - Country:US
Mailing Address - Phone:504-975-6091
Mailing Address - Fax:888-716-7779
Practice Address - Street 1:3834 NEW PROSPERITY LN STE B
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710-3051
Practice Address - Country:US
Practice Address - Phone:504-975-6091
Practice Address - Fax:888-716-7779
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC-6542101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional