Provider Demographics
NPI:1417253303
Name:HAYGOOD, MATTHEW GORDON (LICSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GORDON
Last Name:HAYGOOD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:HAYGOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:1823 H ST NE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4042
Mailing Address - Country:US
Mailing Address - Phone:202-255-1059
Mailing Address - Fax:
Practice Address - Street 1:1823 H ST NE
Practice Address - Street 2:UNIT A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4042
Practice Address - Country:US
Practice Address - Phone:202-255-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793051041C0700X
DCCACII1114101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)