Healthcare Provider Details

I. General information

NPI: 1427962687
Provider Name (Legal Business Name): MARTINA VILLEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

IV. Provider business mailing address

6220 THERMAL RD
CHARLOTTE NC
28211-5630
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-8712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: