Provider Demographics
NPI:1790205250
Name:MARTIN, EARL CLAYTON JR (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:CLAYTON
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 BECKHAM LN APT 404
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3243
Mailing Address - Country:US
Mailing Address - Phone:803-338-8580
Mailing Address - Fax:
Practice Address - Street 1:330 S YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4052
Practice Address - Country:US
Practice Address - Phone:704-864-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0114181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical