Provider Demographics
NPI:1538317789
Name:MARTIN, VICKI D (LPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512-5576
Mailing Address - Country:US
Mailing Address - Phone:870-351-6100
Mailing Address - Fax:870-750-2199
Practice Address - Street 1:408 MARKET ST
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512-3871
Practice Address - Country:US
Practice Address - Phone:870-351-6100
Practice Address - Fax:870-750-2199
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1109069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1366950958OtherCONNECTIONS COUNSELING CENTER, PLLC