| NPI | 1013488394 |
|---|---|
| Former Name | LACEY MARTINEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 13935) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-27217) |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2023-03-16 |