Provider Demographics
NPI:1467754887
Name:MARTIN, CHRISTA NICHOL (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:NICHOL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1750
Mailing Address - Country:US
Mailing Address - Phone:910-528-5591
Mailing Address - Fax:
Practice Address - Street 1:5007 SOUTHPARK DR STE 200E
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7739
Practice Address - Country:US
Practice Address - Phone:910-528-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical