Provider Demographics
NPI:1831627629
Name:MARTIN, AUTUMN S (LCSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32905 W 12 MILE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3345
Mailing Address - Country:US
Mailing Address - Phone:248-296-3104
Mailing Address - Fax:
Practice Address - Street 1:BRIGHTSPOT COUNSELING
Practice Address - Street 2:28592 ORCHARD LAKE RD
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-742-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011085601041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other