Provider Demographics
NPI:1972084564
Name:MARTIN, MARGARET LANE (LPC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:LANE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:503 OAKLEIGH PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6297
Mailing Address - Country:US
Mailing Address - Phone:601-506-5922
Mailing Address - Fax:
Practice Address - Street 1:499 KEYWOOD CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3001
Practice Address - Country:US
Practice Address - Phone:601-718-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health