Provider Demographics
NPI:1891874749
Name:MARTIN, DAVID G (MA, LICDC-CS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MA, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 YERRICK RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2359
Mailing Address - Country:US
Mailing Address - Phone:330-733-7661
Mailing Address - Fax:
Practice Address - Street 1:155 N. WATER STREET
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-678-3006
Practice Address - Fax:330-677-7047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923373101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)