Basic Information
| Provider Information | |||||||||
| NPI: | 1396771465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSTERNA | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MED LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 VINE CREST COURT | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649434859 | ||||||||
| FaxNumber: | 8649430718 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 VINE CREST COURT | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642235111 | ||||||||
| FaxNumber: | 8642239245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2151 | SC | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.