Provider Demographics
NPI:1063818664
Name:GREER, MARTA (MA)
Entity type:Individual
Prefix:MISS
First Name:MARTA
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:DIVINE
Other - Middle Name:KINGDOM
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELING
Mailing Address - Street 1:3887 WALT STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4222
Mailing Address - Country:US
Mailing Address - Phone:770-371-6191
Mailing Address - Fax:
Practice Address - Street 1:3887 WALT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4222
Practice Address - Country:US
Practice Address - Phone:770-371-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11137215101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral