Healthcare Provider Details

I. General information

NPI: 1841854445
Provider Name (Legal Business Name): DERSHAWN MATTHEWS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DERSHAWN JEFFERSON MATTHEWS

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 LINDA RD
SANDSTON VA
23150-1307
US

IV. Provider business mailing address

5603 LINDA RD
SANDSTON VA
23150-1307
US

V. Phone/Fax

Practice location:
  • Phone: 804-304-0898
  • Fax:
Mailing address:
  • Phone: 804-304-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010794
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: