Healthcare Provider Details

I. General information

NPI: 1760166672
Provider Name (Legal Business Name): LUCIA ARELI MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BOULEVARD ST
HIGH POINT NC
27262-3802
US

IV. Provider business mailing address

902 BONNER DR
JAMESTOWN NC
27282-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-801-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18757
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: