Provider Demographics
NPI:1215409222
Name:KERN, MATTHEW RAYMOND (MA, LPC-A)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:KERN
Suffix:
Gender:M
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 BROWNWOOD LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4501
Mailing Address - Country:US
Mailing Address - Phone:704-680-2591
Mailing Address - Fax:
Practice Address - Street 1:4190 BROWNWOOD LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4501
Practice Address - Country:US
Practice Address - Phone:704-680-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPC15410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health