Provider Demographics
NPI:1760962542
Name:PETCHENIK, MARTHA M (LPC (A))
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:PETCHENIK
Suffix:
Gender:F
Credentials:LPC (A)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SURRY LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-9769
Mailing Address - Country:US
Mailing Address - Phone:828-606-6830
Mailing Address - Fax:
Practice Address - Street 1:120 CHADWICK SQUARE CT STE C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3200
Practice Address - Country:US
Practice Address - Phone:828-697-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional