Provider Demographics
NPI:1215089669
Name:GROBLE, MARTHA L B (PHD LMHC)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:L B
Last Name:GROBLE
Suffix:
Gender:F
Credentials:PHD LMHC
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:BOGARDUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS ED
Mailing Address - Street 1:1510 BARRS STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-384-3354
Mailing Address - Fax:904-384-4211
Practice Address - Street 1:1510 BARRS STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-384-3354
Practice Address - Fax:904-384-4211
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health