Provider Demographics
NPI:1487819835
Name:MARTIN, CAROL S (C PSYD, THD,)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:C PSYD, THD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 WHITE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4068
Mailing Address - Country:US
Mailing Address - Phone:937-275-7253
Mailing Address - Fax:937-275-7254
Practice Address - Street 1:7211 TAYLORSVILLE RD
Practice Address - Street 2:SUITE #107
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-2376
Practice Address - Country:US
Practice Address - Phone:937-275-7253
Practice Address - Fax:937-275-7254
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral