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General NPI Number Information
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NPI Number | 1386966372
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Entity Type | Individual
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Provider Name | AMY E MATTHEWS LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 12 W WILSON ST
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City | BATAVIA
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State | IL
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Zip | 60510
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Country | US
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Telephone | 773-516-3134
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Fax |
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Provider Business Mailing Address
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Address Line | 12 W WILSON ST
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City | BATAVIA
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State | IL
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Zip | 60510-2891
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Country | US
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Telephone | 773-516-3134
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Fax | 773-516-3134
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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 | 26021
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007316
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License Number State | IL
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