Provider Demographics
NPI:1568695021
Name:MARTIN, RUDOLPH (NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 MACON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-8226
Mailing Address - Country:US
Mailing Address - Phone:706-614-2414
Mailing Address - Fax:706-614-2408
Practice Address - Street 1:3575 MACON RD STE 8
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8226
Practice Address - Country:US
Practice Address - Phone:706-614-2414
Practice Address - Fax:706-614-2408
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005656101Y00000X
AL2786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health