Provider Demographics
NPI:1336655935
Name:SMEAD, MATTHEW BRANDON (LPCA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRANDON
Last Name:SMEAD
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 SPRINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2252
Mailing Address - Country:US
Mailing Address - Phone:859-396-2884
Mailing Address - Fax:
Practice Address - Street 1:810 TYVOLA RD STE 126
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3536
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health