Provider Demographics
NPI:1982009528
Name:MARTIN, AVERRIA TRISHELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVERRIA
Middle Name:TRISHELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 KENYON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5350
Mailing Address - Country:US
Mailing Address - Phone:619-600-0683
Mailing Address - Fax:619-600-0683
Practice Address - Street 1:3575 KENYON ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5350
Practice Address - Country:US
Practice Address - Phone:619-600-0683
Practice Address - Fax:619-600-0683
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist