Provider Demographics
NPI:1285647685
Name:MARTIN, VIOLET M (MSW)
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1841
Mailing Address - Country:US
Mailing Address - Phone:734-308-8360
Mailing Address - Fax:810-750-9151
Practice Address - Street 1:5300 E M 36
Practice Address - Street 2:SUITE D
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9348
Practice Address - Country:US
Practice Address - Phone:734-308-8360
Practice Address - Fax:810-750-9151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801032981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health