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General NPI Number Information
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NPI Number | 1114242419
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Entity Type | Individual
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Provider Name | LORI LYNN MATTISON NBCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 2 SPLIT ROCK DR SUITE 6
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1244
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Country | US
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Telephone | 856-489-8155
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 KINGS HWY N SUITE 206 A
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2304
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Country | US
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Telephone | 215-872-8094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00365200
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License Number State | NJ
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