Provider Demographics
NPI:1841505393
Name:MARTIN, AMY R (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 GARFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1919
Mailing Address - Country:US
Mailing Address - Phone:501-650-6333
Mailing Address - Fax:
Practice Address - Street 1:1380 CENTRAL PARK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4926
Practice Address - Country:US
Practice Address - Phone:540-602-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ARP1312113101YP2500X
KSLCPC2428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201120830AMedicaid