Provider Demographics
NPI:1255774816
Name:MARTINEZ, MICHELE LYNNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LEE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-5645
Mailing Address - Country:US
Mailing Address - Phone:919-920-6864
Mailing Address - Fax:
Practice Address - Street 1:211 LEE DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-5645
Practice Address - Country:US
Practice Address - Phone:919-920-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9658101YP2500X
NCLPC9658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional