Individual
NICOLE RACHEL MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
30150 TELEGRAPH RD STE 245, BINGHAM FARMS, MI 48025-4521
(800) 693-1916
Mailing address
30150 TELEGRAPH RD STE 245, BINGHAM FARMS, MI 48025-4521
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301018348
MI
103T00000X
Psychologist
Primary
6361007646
MI
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
04/04/2019
Last updated
09/22/2021
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