Provider Demographics
NPI:1215353768
Name:MARTINEZ, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4153
Mailing Address - Country:US
Mailing Address - Phone:240-777-4722
Mailing Address - Fax:240-777-4806
Practice Address - Street 1:255 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 145
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4153
Practice Address - Country:US
Practice Address - Phone:240-777-4722
Practice Address - Fax:240-777-4806
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)