Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 156F00000X | Technician/Technologist |
NPI | 1134700198 |
---|---|
Provider Name | David Michael Martin |
First Address | Harleysville, PA 19438-2416 |
Second Address | Harleysville, PA 19438-2416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 20/04/2021 |