Provider Demographics
NPI:1922717065
Name:MARTIN, RICKI BRIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:RICKI
Middle Name:BRIANA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
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 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:601-533-7016
Practice Address - Street 1:5339 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8243
Practice Address - Country:US
Practice Address - Phone:901-504-7002
Practice Address - Fax:901-389-5661
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13784104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker