Provider Demographics
NPI:1326243783
Name:MARTIN, HOLLY PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:PATRICIA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LEGHORN DR
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-5311
Mailing Address - Country:US
Mailing Address - Phone:919-404-1552
Mailing Address - Fax:
Practice Address - Street 1:2515 NC HWY 55
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1374
Practice Address - Country:US
Practice Address - Phone:919-957-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist