Provider Demographics
NPI:1730887977
Name:MARTINEAU, GREY OCEAN (BA, RBT)
Entity type:Individual
Prefix:
First Name:GREY
Middle Name:OCEAN
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 SHADE VALLEY RD APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-8314
Mailing Address - Country:US
Mailing Address - Phone:517-420-2596
Mailing Address - Fax:
Practice Address - Street 1:280 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6350
Practice Address - Country:US
Practice Address - Phone:704-440-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-22-232966106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician