Provider Demographics
NPI:1588214233
Name:MARTIN, SALINA RAE (LMHC)
Entity type:Individual
Prefix:
First Name:SALINA
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13404 WILD CITRUS RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9050
Mailing Address - Country:US
Mailing Address - Phone:619-646-8487
Mailing Address - Fax:
Practice Address - Street 1:534 S PINEAPPLE AVE STE 5
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7024
Practice Address - Country:US
Practice Address - Phone:941-312-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health