Provider Demographics
NPI:1427679562
Name:MARTIN, ARIEL KRISTIN MOONE (LCSW-A)
Entity type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:KRISTIN MOONE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:MISS
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:MOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:1913 J N PEASE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4537
Mailing Address - Country:US
Mailing Address - Phone:803-084-5009
Mailing Address - Fax:
Practice Address - Street 1:1913 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4537
Practice Address - Country:US
Practice Address - Phone:803-084-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0129471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical