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General NPI Number Information
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NPI Number | 1518787217
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Entity Type | Individual
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Provider Name | JAXELI MARTINEZ-GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 478 BERNARD BLEDSOE LN
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City | TODD
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State | NC
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Zip | 28684-9405
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Country | US
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Telephone | 980-389-9719
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Fax |
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Provider Business Mailing Address
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Address Line | 478 BERNARD BLEDSOE LN
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City | TODD
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State | NC
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Zip | 28684-9405
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Country | US
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Telephone | 980-389-9719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 698191
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A20663
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License Number State | NC
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