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General NPI Number Information
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NPI Number | 1619203544
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Entity Type | Individual
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Provider Name | MRS. OLGA MAGALYS MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 351 WAGONER DR STE 350
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4688
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Country | US
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Telephone | 910-401-3855
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Fax | 866-568-2099
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Provider Business Mailing Address
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Address Line | PO BOX 35266
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-0266
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Country | US
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Telephone | 910-401-3855
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Fax | 866-568-2099
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8303
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1498
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License Number State | NC
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