Provider Demographics
NPI:1487186052
Name:SUGHRUE, MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SUGHRUE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1358
Mailing Address - Country:US
Mailing Address - Phone:301-807-1266
Mailing Address - Fax:
Practice Address - Street 1:6800 FLEETWOOD RD
Practice Address - Street 2:UNIT 111
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3620
Practice Address - Country:US
Practice Address - Phone:301-807-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001368106H00000X
MDLCM550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist