MEDICARE: MRS. TELINA FAYE MATHEWS MA, 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	6824	NC
2	101YS0200X	School Counselor	6824	NC
3	101YM0800X	Mental Health Counselor	S6824	NC

General Provider Information

NPI Number	:	1841473212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TELINA FAYE MATHEWS MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 73081
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27722-3081
Country	:	US
Telephone Number	:	919-886-8008
Fax Number	:	919-477-1848

Provider Business Practice Location Address
First Line	:	106 W CHURCH ST STE H
Second Line	:
City	:	CREEDMOOR
State	:	NC
Zip	:	27522-9765
Country	:	US
Telephone Number	:	919-886-8008
Fax Number	:	919-477-1848

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

Provider Enumeration Date	:	12/08/2007
Last Update Date	:	05/20/2024

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