Provider Demographics
NPI:1306395074
Name:MATHESON, PHILIPPA ELOISE (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:ELOISE
Last Name:MATHESON
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CANTERBURY PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1901
Mailing Address - Country:US
Mailing Address - Phone:757-903-5349
Mailing Address - Fax:
Practice Address - Street 1:103 CANTERBURY PL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1901
Practice Address - Country:US
Practice Address - Phone:757-903-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006717101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor