Provider Demographics
NPI:1578387577
Name:MARTIN, TALESSIA LATAINA (CDCA PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:TALESSIA
Middle Name:LATAINA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CDCA PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 PROJECT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3028
Mailing Address - Country:US
Mailing Address - Phone:216-262-6150
Mailing Address - Fax:
Practice Address - Street 1:3033 PROJECT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3028
Practice Address - Country:US
Practice Address - Phone:216-262-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005740175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist