Provider Demographics
NPI:1164130357
Name:RIEGEL, MATTHEW CRAIG (LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CRAIG
Last Name:RIEGEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BRADLEY PARK LN APT 506
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3065
Mailing Address - Country:US
Mailing Address - Phone:678-578-7111
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2482
Practice Address - Country:US
Practice Address - Phone:678-578-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional