Provider Demographics
NPI:1821100405
Name:MARTIN, NANETTE J (LCPC,CADC)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCPC,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20635 ABBEY WOODS CT N STE 209
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3188
Mailing Address - Country:US
Mailing Address - Phone:815-640-1669
Mailing Address - Fax:
Practice Address - Street 1:20635 ABBEY WOODS CT N STE 209
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3188
Practice Address - Country:US
Practice Address - Phone:815-640-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4055101YA0400X
IL180001063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)