Provider Demographics
NPI:1255825295
Name:MARTIN, PEPPER LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PEPPER
Middle Name:LEIGH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 PATRICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171
Mailing Address - Country:US
Mailing Address - Phone:276-693-3381
Mailing Address - Fax:
Practice Address - Street 1:338 PATRICK AVENUE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-2581
Practice Address - Country:US
Practice Address - Phone:276-693-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007504101YP2500X, 261QM0850X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health