Provider Demographics
NPI:1972523561
Name:EARLY, MARTHA T (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:T
Last Name:EARLY
Suffix:
Gender:F
Credentials:LCSW, LCAS, CCS
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC732101YA0400X
NCC0029401041C0700X
VA09040037051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972523561OtherVALUE OPTIONS
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherAETNA
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORECARE
VA1972523561OtherCOVENTRY HEALTH
VA2711554OtherCIGNA BEHAVIORAL HEALTH
VA365405OtherANTHEM BEHAVIORAL HEALTH (PORTSMOUTH FAMILY MEDICINE)
VA600538-662OtherMAGELLAN HEALTH SERVICES
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherSENTARA/OPTIMA BEHAVIORAL HEALTH
VA365403OtherANTHEM BEHAVIORAL HEALTH (GHENT FAMILY MEDICINE)
VA1972523561Medicaid
VA1972523561Medicaid
VAMC12012Medicare PIN