Provider Demographics
NPI:1730809351
Name:MARTIN, LINDA ANN (LMHC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15973 SW CHARLIE WOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-4917
Mailing Address - Country:US
Mailing Address - Phone:850-363-9657
Mailing Address - Fax:
Practice Address - Street 1:15973 SW CHARLIE WOOD RD
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-4917
Practice Address - Country:US
Practice Address - Phone:850-363-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH21540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health