Provider Demographics
NPI:1013691948
Name:ENGSTROM, MARTHA PITTMAN
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:PITTMAN
Last Name:ENGSTROM
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 1:210 WASHINGTON ST NW STE 206
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3656
Mailing Address - Country:US
Mailing Address - Phone:770-758-4940
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON ST NW STE 206
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3656
Practice Address - Country:US
Practice Address - Phone:770-758-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health