Provider Demographics
NPI:1063914471
Name:MARTIN, JONATHAN SANFORD (LPC-A)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SANFORD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC-A
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 53
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-0053
Mailing Address - Country:US
Mailing Address - Phone:513-600-4511
Mailing Address - Fax:
Practice Address - Street 1:1405A S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2603
Practice Address - Country:US
Practice Address - Phone:910-252-6389
Practice Address - Fax:252-638-7586
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13652101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health