Provider Demographics
NPI:1457875932
Name:MARTIN, DERRICK FRANCIS (LPCC-S)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:FRANCIS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 CENTER RD STE J
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3693
Mailing Address - Country:US
Mailing Address - Phone:330-510-5221
Mailing Address - Fax:
Practice Address - Street 1:3511 CENTER RD STE J
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3693
Practice Address - Country:US
Practice Address - Phone:330-510-5221
Practice Address - Fax:330-510-5228
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health