Healthcare Provider Details

I. General information

NPI: 1427638584
Provider Name (Legal Business Name): MATTHEWS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 MANN DR STE 100
MATTHEWS NC
28105-5511
US

IV. Provider business mailing address

1517 LANDIS AVE
CHARLOTTE NC
28205-3535
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-6861
  • Fax: 844-840-3193
Mailing address:
  • Phone: 336-403-4181
  • Fax: 844-840-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN WRIGHT EGLESTON
Title or Position: THERAPIST
Credential: LCMHC, LCAS
Phone: 704-659-6861