MEDICARE: LACHRISIA LORRAINE MATTHEWS LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC4547	MD

General Provider Information

NPI Number	:	1578819785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACHRISIA LORRAINE MATTHEWS LCPC

Provider Business Mailing Address
First Line	:	4002 BRIDLE RIDGE RD
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-8095
Country	:	US
Telephone Number	:	202-250-4393
Fax Number	:

Provider Business Practice Location Address
First Line	:	10711 RED RUN BLVD STE 112
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5138
Country	:	US
Telephone Number	:	202-250-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/06/2023

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