Provider Demographics
NPI:1073296588
Name:REESE, MATTHEW BRIAN (APC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRIAN
Last Name:REESE
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CLEARVIEW PL
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2116
Mailing Address - Country:US
Mailing Address - Phone:678-850-5159
Mailing Address - Fax:
Practice Address - Street 1:2801 CLEARVIEW PL
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2116
Practice Address - Country:US
Practice Address - Phone:678-850-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007738101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor