Provider Demographics
NPI:1457301079
Name:MARTIN, CHESTER MICHAEL (LPC, LPCS, ACS, NBCC)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:MICHAEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC, LPCS, ACS, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ARSENAL AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5478
Mailing Address - Country:US
Mailing Address - Phone:910-323-3368
Mailing Address - Fax:910-486-7000
Practice Address - Street 1:901 ARSENAL AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5478
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:910-486-7000
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS967OtherNC BOARD OF LICENSED PROFESSIONAL COUNSELORS
NC6102069Medicaid