Provider Demographics
NPI:1194366732
Name:MATHEWS, HANNAH R (CDCA)
Entity Type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:R
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3919
Mailing Address - Country:US
Mailing Address - Phone:740-353-8863
Mailing Address - Fax:740-354-7854
Practice Address - Street 1:605 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3919
Practice Address - Country:US
Practice Address - Phone:740-353-8863
Practice Address - Fax:740-354-7854
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.171708101YA0400X
OHCDCA.175362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.175362OtherCDCA