MEDICARE: MR. JESSE CHARLES MARTIN LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1982985958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESSE CHARLES MARTIN LPCA

Provider Business Mailing Address
First Line	:	2945 S MIAMI BLVD
Second Line	:	SUITE 103
City	:	DURHAM
State	:	NC
Zip	:	27703-8024
Country	:	US
Telephone Number	:	919-616-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 S MIAMI BLVD
Second Line	:	SUITE 103
City	:	DURHAM
State	:	NC
Zip	:	27703-8024
Country	:	US
Telephone Number	:	919-616-1546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	11/19/2013

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