Provider Demographics
NPI:1972119543
Name:MARTINSON, MIA (MED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST STE 300A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-5110
Mailing Address - Country:US
Mailing Address - Phone:865-458-8176
Mailing Address - Fax:
Practice Address - Street 1:200 N MAIN ST STE 300A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-5110
Practice Address - Country:US
Practice Address - Phone:865-458-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
SC8515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional