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General NPI Number Information
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NPI Number | 1619022142
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Entity Type | Individual
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Provider Name | SUSAN SLATE MATHEWS-DUVALL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 210
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City | ROANOKE
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State | VA
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Zip | 24018-4507
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Country | US
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Telephone | 540-206-2385
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21016
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City | ROANOKE
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State | VA
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Zip | 24018-0103
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Country | US
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Telephone | 859-227-9998
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | P0000002539
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | KY-1482
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 0810006100
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License Number State | VA
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