Provider Demographics
NPI:1821491051
Name:MARTIN, AMBER MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3201
Mailing Address - Country:US
Mailing Address - Phone:601-395-0261
Mailing Address - Fax:601-600-2428
Practice Address - Street 1:700 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-395-0261
Practice Address - Fax:601-299-9012
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional