Provider Demographics
NPI:1992035406
Name:MARTINELLI, GINA C (MS, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:C
Last Name:MARTINELLI
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1848
Mailing Address - Country:US
Mailing Address - Phone:850-726-0937
Mailing Address - Fax:
Practice Address - Street 1:103 E MONTANA AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-1706
Practice Address - Country:US
Practice Address - Phone:850-547-1230
Practice Address - Fax:850-547-1230
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health