Provider Demographics
NPI:1669258679
Name:MARTINE, DARIUS CHRISTOPHER (LMFT141004)
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:CHRISTOPHER
Last Name:MARTINE
Suffix:
Gender:M
Credentials:LMFT141004
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10749 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1506
Mailing Address - Country:US
Mailing Address - Phone:818-741-0104
Mailing Address - Fax:
Practice Address - Street 1:10749 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1506
Practice Address - Country:US
Practice Address - Phone:818-741-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist