Provider Demographics
NPI:1558961441
Name:MARTIN, SAVANNA (LPC, CSAC, LAC)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, CSAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4393 KEVIN WALKER DR # 1010
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1636
Mailing Address - Country:US
Mailing Address - Phone:804-603-0465
Mailing Address - Fax:
Practice Address - Street 1:4229 LAFAYETTE CENTER DR STE 1675
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1270
Practice Address - Country:US
Practice Address - Phone:571-354-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD19021812101YA0400X
SDLPC20574101YM0800X
VA0701010674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)