Provider Demographics
NPI:1538294178
Name:DURHAM, MARTHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:DURHAM
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 1:101 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1631
Mailing Address - Country:US
Mailing Address - Phone:864-354-0143
Mailing Address - Fax:864-271-8712
Practice Address - Street 1:101 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1631
Practice Address - Country:US
Practice Address - Phone:864-354-0143
Practice Address - Fax:864-271-8712
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC981103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ34031Medicare ID - Type Unspecified