Provider Demographics
NPI:1215537493
Name:MARTIN, CHRISTINE ERIN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ERIN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ERIN
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3511 CENTER RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-510-5221
Mailing Address - Fax:
Practice Address - Street 1:3511 CENTER RD
Practice Address - Street 2:SUITE J
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-510-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2102962101Y00000X
OHCDCA.171116101YA0400X
OHE2303835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)