Healthcare Provider Details

I. General information

NPI: 1528770880
Provider Name (Legal Business Name): KRISTINA R MATHEWS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 S HOWARD AVE
GETTYSBURG PA
17325-2409
US

IV. Provider business mailing address

264 S HOWARD AVE
GETTYSBURG PA
17325-2409
US

V. Phone/Fax

Practice location:
  • Phone: 443-340-7152
  • Fax:
Mailing address:
  • Phone: 443-340-7152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC015122
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: