Healthcare Provider Details

I. General information

NPI: 1093428658
Provider Name (Legal Business Name): JACQUELINE MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 8TH ST SE STE 219
HICKORY NC
28602-1121
US

IV. Provider business mailing address

260 1ST AVE NW STE 201
HICKORY NC
28601-6161
US

V. Phone/Fax

Practice location:
  • Phone: 828-979-6392
  • Fax:
Mailing address:
  • Phone: 828-855-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: