Provider Demographics
NPI:1255720314
Name:MARTIN, JALEESA (MS, LCASA)
Entity type:Individual
Prefix:
First Name:JALEESA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 PADDOCK DR
Mailing Address - Street 2:SUITE E-100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4873
Mailing Address - Country:US
Mailing Address - Phone:919-790-2446
Mailing Address - Fax:919-790-9755
Practice Address - Street 1:1306 PADDOCK DR
Practice Address - Street 2:SUITE E-100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4873
Practice Address - Country:US
Practice Address - Phone:919-790-2446
Practice Address - Fax:919-790-9755
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21352101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)