Basic Information
| Provider Information | |||||||||
| NPI: | 1598158867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WISBEY | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D., LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 261 SUNSET TER | ||||||||
| Address2: | |||||||||
| City: | FORSYTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310291674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508430142 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1965 CAPITAL CIR NE STE 102 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323088402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506714600 | ||||||||
| FaxNumber: | 8508782863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2015 | ||||||||
| LastUpdateDate: | 03/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW11463 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.