Provider Demographics
NPI:1588233480
Name:MARTIN, GREGORY DEAN (CSAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-134 KUAHELANI AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1562
Mailing Address - Country:US
Mailing Address - Phone:808-852-7655
Mailing Address - Fax:
Practice Address - Street 1:95-134 KUAHELANI AVE APT 118
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1562
Practice Address - Country:US
Practice Address - Phone:808-852-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)