Provider Demographics
NPI:1508685785
Name:MARTIN, TIMOTHY PIERRE (EDS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PIERRE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PENTON CT
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2413
Mailing Address - Country:US
Mailing Address - Phone:334-399-3027
Mailing Address - Fax:
Practice Address - Street 1:44 PENTON CT
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-2413
Practice Address - Country:US
Practice Address - Phone:334-399-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health