Provider Demographics
NPI:1710118195
Name:MARTIN, JULIE LYNNETTE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CANTERBURY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7765
Mailing Address - Country:US
Mailing Address - Phone:704-576-2230
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7437
Practice Address - Country:US
Practice Address - Phone:704-576-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health