Healthcare Provider Details

I. General information

NPI: 1285073718
Provider Name (Legal Business Name): KRISTIN YOLANDA MATTHEWS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 ESSEX RD
GWYNN OAK MD
21207-4531
US

IV. Provider business mailing address

3402 ESSEX RD
GWYNN OAK MD
21207-4531
US

V. Phone/Fax

Practice location:
  • Phone: 443-904-6522
  • Fax:
Mailing address:
  • Phone: 443-904-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13922
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: