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General NPI Number Information
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NPI Number | 1154943363
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Entity Type | Individual
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Provider Name | BRIAN WESLEY MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1400 FLORIDA AVE NE APT 911
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City | WASHINGTON
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State | DC
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Zip | 20002-5028
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Country | US
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Telephone | 202-399-1704
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 45TH PL SE
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City | WASHINGTON
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State | DC
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Zip | 20019-5716
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Country | US
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Telephone | 202-808-1975
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1349
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License Number State | DC
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