Provider Demographics
NPI:1588236202
Name:MARTIN, CHARLOTTE MARIE (CLC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E MAIN ST APT 1416
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4278
Mailing Address - Country:US
Mailing Address - Phone:803-466-8805
Mailing Address - Fax:
Practice Address - Street 1:2120 N BELTLINE BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4518
Practice Address - Country:US
Practice Address - Phone:803-782-0528
Practice Address - Fax:803-782-0528
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
326178174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN