Provider Demographics
NPI:1164438941
Name:MARTIN, DEIRDRE K (LMHC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E MARTIN LUTHER KING JR DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4864
Mailing Address - Country:US
Mailing Address - Phone:813-252-0900
Mailing Address - Fax:
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR
Practice Address - Street 2:SUITE 290
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4864
Practice Address - Country:US
Practice Address - Phone:813-252-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health