Provider Demographics
NPI:1881713816
Name:MARTIN, KATHRYN BLAIR (MSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BLAIR
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 SUMMIT AVE # B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7740
Mailing Address - Country:US
Mailing Address - Phone:803-414-4332
Mailing Address - Fax:336-931-1801
Practice Address - Street 1:7900 TRIAD CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9073
Practice Address - Country:US
Practice Address - Phone:336-931-1812
Practice Address - Fax:336-931-1801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor