Provider Demographics
NPI:1407582166
Name:MARTIN, CAROL JEAN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:MARTIN-NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 LAFAYETTE ST STE 140B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5762
Mailing Address - Country:US
Mailing Address - Phone:504-533-9152
Mailing Address - Fax:504-533-9154
Practice Address - Street 1:1500 LAFAYETTE ST STE 140B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5762
Practice Address - Country:US
Practice Address - Phone:504-533-9152
Practice Address - Fax:504-533-9154
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health