Provider Demographics
NPI:1164936449
Name:MARTIN, GRETA ROSE (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:ROSE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OAK POINT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2447
Mailing Address - Country:US
Mailing Address - Phone:919-601-9260
Mailing Address - Fax:
Practice Address - Street 1:3401 CARL SANDBURG CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2049
Practice Address - Country:US
Practice Address - Phone:919-212-8580
Practice Address - Fax:919-212-8581
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041S0200X
NCP011945104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker