Healthcare Provider Details

I. General information

NPI: 1639934052
Provider Name (Legal Business Name): CARLIE TONER MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 KILDAIRE FARM RD STE 206
CARY NC
27511-4597
US

IV. Provider business mailing address

1140 KILDAIRE FARM RD STE 206
CARY NC
27511-4597
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-1537
  • Fax:
Mailing address:
  • Phone: 919-213-1537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: