MEDICARE: MATTHEW DAVID ROUGHGARDEN LCSW-A, LCAS-A

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-30947	NC
2	1041C0700X	Clinical Social Worker	P022679	NC

General Provider Information

NPI Number	:	1801755483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID ROUGHGARDEN LCSW-A, LCAS-A

Provider Business Mailing Address
First Line	:	2670 DURHAM CHAPEL HILL BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2829
Country	:	US
Telephone Number	:	919-251-9001
Fax Number	:	919-251-9008

Provider Business Practice Location Address
First Line	:	3012 FALSTAFF RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1813
Country	:	US
Telephone Number	:	919-615-1027
Fax Number	:	919-615-1501

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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