Provider Demographics
NPI:1053321687
Name:MATTHEWS, TATIANA Y. (MS)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA Y.
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BALL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4467
Mailing Address - Country:US
Mailing Address - Phone:770-815-6853
Mailing Address - Fax:
Practice Address - Street 1:1730 MOUNT VERNON RD STE G
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4245
Practice Address - Country:US
Practice Address - Phone:707-815-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00359OtherLPC