Provider Demographics
NPI:1417404963
Name:MARTINEZ, DEREK (M ED/ED S)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:M ED/ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4503
Mailing Address - Country:US
Mailing Address - Phone:813-728-3113
Mailing Address - Fax:
Practice Address - Street 1:304 NEW LEICESTER HWY # A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2021
Practice Address - Country:US
Practice Address - Phone:828-232-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health