Provider Demographics
NPI:1336489012
Name:MARTIN, LAWANDA (LPC)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
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 1:401 E SONTERRA BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4321
Mailing Address - Country:US
Mailing Address - Phone:757-867-5811
Mailing Address - Fax:757-384-1581
Practice Address - Street 1:401 E SONTERRA BLVD STE 375
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4321
Practice Address - Country:US
Practice Address - Phone:757-867-5811
Practice Address - Fax:757-384-1581
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006966101YM0800X
101YP2500X, 101Y00000X, 101YA0400X, 101YM0800X
FLMH13508101YP2500X
TX85425101YP2500X
VA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA823587210OtherENGEDI THERAPY SERVICES, PLLC
VA823587210OtherENGEDI THERAPY SERVICES, PLLC