Provider Demographics
NPI:1700018876
Name:MARTIN, ANDREW DOUGLAS (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WEBSTER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2336
Mailing Address - Country:US
Mailing Address - Phone:704-750-5524
Mailing Address - Fax:704-918-1408
Practice Address - Street 1:756 TYVOLA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3588
Practice Address - Country:US
Practice Address - Phone:704-750-5524
Practice Address - Fax:704-918-1408
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional