Provider Demographics
NPI:1912710898
Name:MARTINEZ, JOSE (LCMHC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 REAFIELD DR APT 16
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3597
Mailing Address - Country:US
Mailing Address - Phone:704-942-5926
Mailing Address - Fax:
Practice Address - Street 1:6614 REAFIELD DR APT 16
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3597
Practice Address - Country:US
Practice Address - Phone:704-942-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health