Provider Demographics
NPI:1629493101
Name:DEAHL, MARTIN (NCACII,CSAC,SAP,QMHP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DEAHL
Suffix:
Gender:M
Credentials:NCACII,CSAC,SAP,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 WESTCOTT ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1922
Mailing Address - Country:US
Mailing Address - Phone:703-224-8929
Mailing Address - Fax:
Practice Address - Street 1:2331 OLD MILL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:703-224-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102778101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)