Provider Demographics
NPI:1619203544
Name:MARTINEZ, OLGA MAGALYS
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:MAGALYS
Last Name:MARTINEZ
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:PO BOX 35266
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0266
Mailing Address - Country:US
Mailing Address - Phone:910-401-3855
Mailing Address - Fax:866-568-2099
Practice Address - Street 1:351 WAGONER DR STE 350
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4688
Practice Address - Country:US
Practice Address - Phone:910-401-3855
Practice Address - Fax:866-568-2099
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8303101YP2500X
NC1498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional