MEDICARE: MRS. MICHELLE ANNE MATTHEWS LPC

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	101YP2500X	Professional Counselor	4207	GA

General Provider Information

NPI Number	:	1720241870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ANNE MATTHEWS LPC

Provider Business Mailing Address
First Line	:	92 OLD STILL CT
Second Line	:
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-0974
Country	:	US
Telephone Number	:	404-213-4246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 OLD DAWSON VILLAGE RD E STE 20
Second Line	:
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-3807
Country	:	US
Telephone Number	:	404-213-4246
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	11/01/2022

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