Provider Demographics
NPI:1457763153
Name:MARTIN, NANCY (LPCC, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 RAFF RD SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2317
Mailing Address - Country:US
Mailing Address - Phone:330-479-1912
Mailing Address - Fax:330-479-1916
Practice Address - Street 1:1375 RAFF RD SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2317
Practice Address - Country:US
Practice Address - Phone:330-479-1912
Practice Address - Fax:330-479-1916
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH892699101YA0400X
OHE1817101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health