Provider Demographics
NPI:1962553313
Name:MARTINO, DANIEL F (LPC, CSAC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:F
Last Name:MARTINO
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459A CARLISLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5607
Mailing Address - Country:US
Mailing Address - Phone:703-237-3743
Mailing Address - Fax:
Practice Address - Street 1:459 CARLISLE DR STE A
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5607
Practice Address - Country:US
Practice Address - Phone:703-237-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710100902101YA0400X
VA0701005225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)