Healthcare Provider Details

I. General information

NPI: 1902714082
Provider Name (Legal Business Name): ANN-MARIE MATTHEW-THOMAS CSAC, MSW-SUPERVISEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 HENNEMAN DR STE A
NORFOLK VA
23513-2401
US

IV. Provider business mailing address

5375 HENNEMAN DR STE A
NORFOLK VA
23513-2401
US

V. Phone/Fax

Practice location:
  • Phone: 757-597-1909
  • Fax:
Mailing address:
  • Phone: 757-597-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710104089
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: