Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1403 | AR |
Y | 101YM0800X | Mental Health Counselor | MH15370 | FL |
N | 101YM0800X | Mental Health Counselor | P1103014 | AR |
N | 101YP1600X | Pastoral Counselor | 14152 | NC |
NPI | 1205003720 |
---|---|
Provider Name | Deva Martinez |
First Address | Valrico, FL 33596-6132 |
Second Address | Valrico, FL 33596-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 20/07/2021 |