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General NPI Number Information
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NPI Number | 1972813541
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Entity Type | Organization
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Legal Business Name | LATASHA MATTHEWS, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 392 CLEARSPRINGS DRIVE
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 404-914-2521
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Fax |
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Provider Business Mailing Address
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Address Line | 392 CLEARSPRINGS DRIVE
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST
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Name | LATASHA MATTHEWS
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Credential | LAPC
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Telephone | 404-914-2521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | APC002122
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License Number State | GA
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