Provider Demographics
NPI:1467958512
Name:MARTINEZ, ALEXANDRIA JORDEN (CDCA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:JORDEN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9466
Mailing Address - Country:US
Mailing Address - Phone:419-747-3322
Mailing Address - Fax:
Practice Address - Street 1:106 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-710-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2876928Medicaid