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General NPI Number Information
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NPI Number | 1740904952
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Entity Type | Individual
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Provider Name | JENNIFER MARTIN LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 871 WASHINGTON ST
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City | RALEIGH
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State | NC
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Zip | 27605-1499
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Country | US
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Telephone | 919-229-9834
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 BROOK CROSSING CIR
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City | RALEIGH
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State | NC
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Zip | 27606-3169
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Country | US
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Telephone | 716-400-4382
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A17986
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License Number State | NC
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