Provider Demographics
NPI:1578660361
Name:MARTIN, EVELINA CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVELINA
Middle Name:CAROL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 46TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3232
Mailing Address - Country:US
Mailing Address - Phone:806-470-2841
Mailing Address - Fax:806-793-0932
Practice Address - Street 1:6630 QUAKER AVE STE 102
Practice Address - Street 2:DIALYSIS CENTER OF LUBBOCK
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5939
Practice Address - Country:US
Practice Address - Phone:806-793-1414
Practice Address - Fax:806-793-0932
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSW 253341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW 25334OtherLICENSED CLNICAL SOCIAL W