Provider Demographics
NPI:1750649752
Name:MARTZ, VANESSA HOLME (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:HOLME
Last Name:MARTZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36072-1103
Mailing Address - Country:US
Mailing Address - Phone:334-687-5056
Mailing Address - Fax:
Practice Address - Street 1:1633 CALHOUN DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-5643
Practice Address - Country:US
Practice Address - Phone:334-687-5056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006778103K00000X
AL1770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist