Provider Demographics
NPI:1235675588
Name:DIKE, MARTINS (MA PHIL, CAP)
Entity Type:Individual
Prefix:
First Name:MARTINS
Middle Name:
Last Name:DIKE
Suffix:
Gender:M
Credentials:MA PHIL, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-2008
Mailing Address - Country:US
Mailing Address - Phone:561-983-2424
Mailing Address - Fax:
Practice Address - Street 1:500 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2008
Practice Address - Country:US
Practice Address - Phone:561-983-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-009449-2015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional