Provider Demographics
NPI:1255362869
Name:MARTIN, JOSEPH E (LCSW LCAS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW LCAS
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 397
Mailing Address - Street 2:129 SKYVIEW CIRCLE
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-9518
Mailing Address - Country:US
Mailing Address - Phone:828-765-0037
Mailing Address - Fax:828-765-0039
Practice Address - Street 1:129 SKYVIEW CIR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-9518
Practice Address - Country:US
Practice Address - Phone:828-765-0037
Practice Address - Fax:828-765-0039
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003034Medicaid
2862723BOtherMEDICARE ENROLLMENT FOR NEW VISTAS BEHAVIORAL HEALTH SERVICES, INC.
NC2862723AOtherMEDICARE NUMBER FOR BLUE RIDGE CENTER
2862723COtherMEDICARE ENROLLMENT FOR ALPHA OMEGA HEALTH, INC.