Basic Information
| Provider Information | |||||||||
| NPI: | 1013185313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PCC-S, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 SIERRA LN | ||||||||
| Address2: | |||||||||
| City: | ARCANUM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453041361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376380544 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 212 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375481635 | ||||||||
| FaxNumber: | 9375481500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S0027502 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | E1000082-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.