Individual
EBONY MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHC-A
Contact information
Practice address
516 RIVER HWY STE D246, MOORESVILLE, NC 28117-7808
(704) 228-6103
(704) 368-1916
Mailing address
516 RIVER HWY STE D246, MOORESVILLE, NC 28117-7808
(704) 228-6103
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A16830
NC
103K00000X
Behavior Analyst
QASP-S9012
GA
103K00000X
Behavior Analyst
RBT-16-20302
GA
Other
Enumeration date
08/28/2017
Last updated
12/02/2021
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