Healthcare Provider Details

I. General information

NPI: 1043165509
Provider Name (Legal Business Name): ALICIA MONAY MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ELLA KINLEY CIR UNIT 401
MYRTLE BEACH SC
29588-4700
US

IV. Provider business mailing address

133 ELLA KINLEY CIR UNIT 401
MYRTLE BEACH SC
29588-4700
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-9000
  • Fax:
Mailing address:
  • Phone:
  • 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: