Provider Demographics
NPI:1588687339
Name:PERRY, MARTHA ANNE (PHD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANNE
Other - Last Name:VINETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464 BEAVERDAM RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 STONE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-8313
Practice Address - Country:US
Practice Address - Phone:828-645-9305
Practice Address - Fax:828-645-1038
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000528Medicaid
NC4562OtherNVML BCBSNC GRP 015HF
NC4562OtherNVML BCBSNC GRP 015HF