MEDICARE: MATTHEW JON MCUMBER LCSW, LADAC, CADC II

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	1158	TN
2	1041C0700X	Clinical Social Worker	6464	TN
3	1041C0700X	Clinical Social Worker	6110	GA

General Provider Information

NPI Number	:	1851811780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JON MCUMBER LCSW, LADAC, CADC II

Provider Business Mailing Address
First Line	:	3091 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-4003
Country	:	US
Telephone Number	:	706-935-6442
Fax Number	:	706-935-6441

Provider Business Practice Location Address
First Line	:	3091 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-4003
Country	:	US
Telephone Number	:	706-841-0500
Fax Number	:	423-464-7512

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	04/07/2020

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