Individual
LISA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
(503) 391-9762
Mailing address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-06-17
OR
Other
Enumeration date
07/31/2019
Last updated
08/28/2019
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