Provider Demographics
NPI:1144486226
Name:LIND, MARTHA L (LMSW ACSW CAAC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:LIND
Suffix:
Gender:F
Credentials:LMSW ACSW CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:334 W. MAIN STREET
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-0433
Mailing Address - Country:US
Mailing Address - Phone:616-527-9373
Mailing Address - Fax:616-527-9374
Practice Address - Street 1:334 W MAIN ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1650
Practice Address - Country:US
Practice Address - Phone:616-527-9373
Practice Address - Fax:616-527-9374
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010703861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI61-1557314OtherEIN