Provider Demographics
NPI:1013347426
Name:EARLEY, MARTHA LYNNE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNNE
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WINN WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1723
Mailing Address - Country:US
Mailing Address - Phone:334-560-2125
Mailing Address - Fax:706-845-4367
Practice Address - Street 1:122 GORDON COMMERCIAL DR STE C
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5754
Practice Address - Country:US
Practice Address - Phone:706-845-4054
Practice Address - Fax:706-845-4367
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor