Healthcare Provider Details

I. General information

NPI: 1023331089
Provider Name (Legal Business Name): CHANDRA DIANA MATIAS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 TOWN COMMONS DR
HOWELL MI
48855-6803
US

IV. Provider business mailing address

1621 TOWN COMMONS DR
HOWELL MI
48855-6803
US

V. Phone/Fax

Practice location:
  • Phone: 734-497-5835
  • Fax:
Mailing address:
  • Phone: 734-497-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401011672
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: