Provider Demographics
NPI:1235489634
Name:MARTINEZ, LINDSAY NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:NICOLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:CASTILLO-MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:508 E. UNAKA AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601
Mailing Address - Country:US
Mailing Address - Phone:276-328-8012
Mailing Address - Fax:276-386-2116
Practice Address - Street 1:190 BEECH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3600
Practice Address - Country:US
Practice Address - Phone:276-386-3803
Practice Address - Fax:276-386-2116
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA081005796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program