Provider Demographics
NPI:1720305014
Name:MARTIN, CHRISTOPHER S (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES H QUILLEN VAMC
Mailing Address - Street 2:BUILDING 8, DOGWOOD AVE
Mailing Address - City:MONTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JAMES H QUILLEN VAMC
Practice Address - Street 2:BUILDING 8, DOGWOOD AVE
Practice Address - City:MONTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical