Provider Demographics
NPI:1073943858
Name:MARTINEZ-CUNION, EDERIS
Entity Type:Individual
Prefix:
First Name:EDERIS
Middle Name:
Last Name:MARTINEZ-CUNION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N RAILROAD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1528
Mailing Address - Country:US
Mailing Address - Phone:804-798-5327
Mailing Address - Fax:804-368-7490
Practice Address - Street 1:104 N RAILROAD AVE STE A
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1528
Practice Address - Country:US
Practice Address - Phone:804-798-5327
Practice Address - Fax:804-368-7490
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72866101Y00000X
MDLGP5140101YM0800X
VA0701007530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health