Provider Demographics
NPI:1659393874
Name:MARTIN, SARA HINES (MS COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:HINES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 HOLBORN WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4883
Mailing Address - Country:US
Mailing Address - Phone:770-975-7980
Mailing Address - Fax:770-974-0350
Practice Address - Street 1:2365 HIGHWAY 92 STE 100
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7712
Practice Address - Country:US
Practice Address - Phone:770-975-7980
Practice Address - Fax:770-974-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPCA 1473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4733OtherSTATE LPCA LICENSE