Marvin R Martine, LISAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Sanders, AZ
NPI 1104037803 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104037803
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 11363 (AZ)
- Practice address
- 4 MLS S of I-40 on Hwy 191, Sanders
Sanders, AZ 86512-1086 - Phone
- (928) 688-3475
- Fax
- (928) 688-3478
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11363 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newlands Outpatient Treatment Center | Addiction (Substance Use Disorder) | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11363 | AZ | Yes |
Addresses
Primary practice location
4 MLS S of I-40 on Hwy 191, Sanders
Sanders, AZ 86512-1086
Mailing address
PO Box 1086
Sanders, AZ 86512-1086
Phone (928) 688-3475
Other providers in Sanders, AZ
- Carrie Anne Compton
- Kirby David
- Busanda Lee Frost
- Michelle Kahn-John
- Shandina Manycows
- Newlands Outpatient Treatment Center
- Northern Apache County Special Health Care District
- Northern Apache County Special Health Care District
- Puerco Valley Ambulance
- Deborah J Reeves
All providers in Sanders, AZ · Addiction (Substance Use Disorder) Counselor in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.