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NPI Code Detail

MEDICARE: MR. HENRY MADDOX MATTHEWS JR. LPC, CSAC

MEDICARE: MR. HENRY MADDOX MATTHEWS JR. LPC, CSAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor0710101983VA
2101YA0400XAddiction (Substance Use Disorder) Counselor0701003879VA

General Provider Information

NPI Number : 1558397364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HENRY MADDOX MATTHEWS JR. LPC, CSAC
Provider Business Mailing Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Provider Business Practice Location Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 10/23/2023

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