Provider Demographics
NPI:1629058771
Name:FRIEDMAN, MARTIN I (LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:I
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N WITCHDUCK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6544
Mailing Address - Country:US
Mailing Address - Phone:757-497-3670
Mailing Address - Fax:757-499-1947
Practice Address - Street 1:256 N WITCHDUCK RD
Practice Address - Street 2:SUITE G
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6544
Practice Address - Country:US
Practice Address - Phone:757-497-3670
Practice Address - Fax:757-499-1947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001105101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5409772Medicaid