Provider Demographics
NPI:1932378734
Name:CAIN, MARTHA JORDAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JORDAN
Last Name:CAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0062
Mailing Address - Country:US
Mailing Address - Phone:601-978-7867
Mailing Address - Fax:601-978-7860
Practice Address - Street 1:357 TOWNE CENTER BLVD
Practice Address - Street 2:STE 401
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-978-7867
Practice Address - Fax:601-978-7860
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS32473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist