Provider Demographics
NPI:1194037614
Name:MARTINEZ, HOLLY CHRISTINE (CADCII)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SW ALDER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3133
Mailing Address - Country:US
Mailing Address - Phone:503-226-2203
Mailing Address - Fax:
Practice Address - Street 1:808 SW ALDER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3133
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR050765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)