Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LCS 14541 | CA |
N | 101YS0200X | School Counselor | PPS 090095587 | CA |
Y | 1041C0700X | Clinical Social Worker | LCS 14541 | CA |
NPI | 1144459280 |
---|---|
Provider Name | Peggy Ann Martinez |
First Address | Sacramento, CA 95860-0582 |
Second Address | Citrus Heights, CA 95610-0359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 11/02/2022 |