Provider Demographics
NPI:1861854291
Name:MARTIN, MEREDITH (LCSWA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
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:PO BOX 607
Mailing Address - Street 2:1303 GREENSBORO ST. EXT
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0607
Mailing Address - Country:US
Mailing Address - Phone:336-249-0237
Mailing Address - Fax:336-243-2441
Practice Address - Street 1:1303 GREENSBORO STREET EXT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-1924
Practice Address - Country:US
Practice Address - Phone:336-249-0237
Practice Address - Fax:336-243-7685
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0102891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical