Provider Demographics
NPI:1164940540
Name:MARTIN, LOUIS C (CDCA)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 SOUTH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44105
Mailing Address - Country:US
Mailing Address - Phone:216-507-8056
Mailing Address - Fax:
Practice Address - Street 1:13802 S PARKWAY DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6842
Practice Address - Country:US
Practice Address - Phone:216-507-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161202101Y00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101Y00000XBehavioral Health & Social Service ProvidersCounselor