Provider Demographics
NPI:1396771465
Name:BUSTERNA, MARTHA V (MED LPC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:V
Last Name:BUSTERNA
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINE CREST COURT
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-943-4859
Mailing Address - Fax:864-943-0718
Practice Address - Street 1:105 VINE CREST COURT
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-223-5111
Practice Address - Fax:864-223-9245
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2151101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor