Provider Demographics
NPI:1891827358
Name:CLAUS, MARTHA ANN (MED)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:CLAUS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILLSIDE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2172
Mailing Address - Country:US
Mailing Address - Phone:704-332-1725
Mailing Address - Fax:
Practice Address - Street 1:1018 EAST BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5772
Practice Address - Country:US
Practice Address - Phone:704-344-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1047101YP2500X
NC256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist