Healthcare Provider Details

I. General information

NPI: 1073479598
Provider Name (Legal Business Name): ALICIA MARIE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2293 NC 24-87
CAMERON NC
28326-6687
US

IV. Provider business mailing address

206 HEATHER RIDGE DR APT J
FAYETTEVILLE NC
28311-7028
US

V. Phone/Fax

Practice location:
  • Phone: 910-500-7783
  • Fax:
Mailing address:
  • Phone: 919-946-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: