Provider Demographics
NPI:1659848018
Name:ST. MARTIN, GREGORY (MA, NCC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ST. MARTIN
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 EAST BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5114
Mailing Address - Country:US
Mailing Address - Phone:704-301-4022
Mailing Address - Fax:
Practice Address - Street 1:708 EAST BLVD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5114
Practice Address - Country:US
Practice Address - Phone:704-301-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health