Healthcare Provider Details

I. General information

NPI: 1518787217
Provider Name (Legal Business Name): JAXELI MARTINEZ-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CHARLES ST
BOONE NC
28607-3418
US

IV. Provider business mailing address

256 CHARLES ST
BOONE NC
28607-3418
US

V. Phone/Fax

Practice location:
  • Phone: 980-389-9719
  • Fax:
Mailing address:
  • Phone: 980-389-9719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20663
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number698191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: