Provider Demographics
NPI:1629571823
Name:MARTIN, ALEXIS (LPCC, LCDC III)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3971 HOOVER RD STE 247
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2839
Mailing Address - Country:US
Mailing Address - Phone:614-638-6493
Mailing Address - Fax:
Practice Address - Street 1:3455 CENTERPOINT DR STE J
Practice Address - Street 2:
Practice Address - City:URBANCREST
Practice Address - State:OH
Practice Address - Zip Code:43123-1498
Practice Address - Country:US
Practice Address - Phone:614-638-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.101108101YA0400X
OHE.0500460101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health