Provider Demographics
NPI:1588928568
Name:MARTINEZ-GONZALES, ERIKA NICOLE
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:NICOLE
Last Name:MARTINEZ-GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:NICOLE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, MA
Mailing Address - Street 1:4004 CARLISLE BLVD NE STE A2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4566
Mailing Address - Country:US
Mailing Address - Phone:505-261-9770
Mailing Address - Fax:505-565-0040
Practice Address - Street 1:4004 CARLISLE BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4566
Practice Address - Country:US
Practice Address - Phone:505-261-9770
Practice Address - Fax:505-565-0040
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0173531101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health