Provider Demographics
NPI:1245522689
Name:MARTIN, RICHARD JOESPH (MTS, ED D, LCAS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOESPH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MTS, ED D, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WEIR POINT DR
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9409
Mailing Address - Country:US
Mailing Address - Phone:252-202-7636
Mailing Address - Fax:
Practice Address - Street 1:127 WEIR POINT DR
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9409
Practice Address - Country:US
Practice Address - Phone:252-202-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC378101Y00000X
NC46101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor