Provider Demographics
NPI:1851439160
Name:MARTIN, JAMES A (MSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 S HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1129
Mailing Address - Country:US
Mailing Address - Phone:248-299-0764
Mailing Address - Fax:
Practice Address - Street 1:33975 DEQUINDRE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4649
Practice Address - Country:US
Practice Address - Phone:248-585-3239
Practice Address - Fax:248-616-9759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801018390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801018390OtherCOUNSLER MENTAL HEALTH