Provider Demographics
NPI:1750092466
Name:MARTIN, DOROTHY M (N/A)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:M
Other - Last Name:BYARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3293 N SENSENEY CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4697
Mailing Address - Country:US
Mailing Address - Phone:931-343-9727
Mailing Address - Fax:
Practice Address - Street 1:401 S MOUNT JULIET RD STE 235-118
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6359
Practice Address - Country:US
Practice Address - Phone:703-506-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician