Provider Demographics
NPI:1851076285
Name:MARTIN, AMIE KAY (LMSW, MED)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PECAN RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7424
Mailing Address - Country:US
Mailing Address - Phone:619-787-9503
Mailing Address - Fax:
Practice Address - Street 1:22787 US HIGHWAY 98 STE B1
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6330
Practice Address - Country:US
Practice Address - Phone:251-276-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5810G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical