Provider Demographics
NPI:1053155317
Name:GADSON, MARTHA (MSW, CAS)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GADSON
Suffix:
Gender:F
Credentials:MSW, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2242
Mailing Address - Country:US
Mailing Address - Phone:719-237-6535
Mailing Address - Fax:
Practice Address - Street 1:210 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2242
Practice Address - Country:US
Practice Address - Phone:719-237-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0998094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)