Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003369208 |
---|---|
Provider Name | Stephenie Ann Martin |
First Address | Honolulu, HI 96813-5267 |
Second Address | Honolulu, HI 96813-5267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 04/05/2017 |