Healthcare Provider Details

I. General information

NPI: 1558061689
Provider Name (Legal Business Name): DANIELLA MARIE MARTINEZ MA, NCC, LCDC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY STE C
CEDAR PARK TX
78613-7886
US

IV. Provider business mailing address

1401 MEDICAL PKWY STE C
CEDAR PARK TX
78613-7886
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-1811
  • Fax:
Mailing address:
  • Phone: 512-639-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: