Provider Demographics
NPI:1619375425
Name:HAGAN, MATTHEW SHUMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHUMAN
Last Name:HAGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MARSHALL
Other - Middle Name:SHUMAN
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1505 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2716
Mailing Address - Country:US
Mailing Address - Phone:703-548-4447
Mailing Address - Fax:
Practice Address - Street 1:1505 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2716
Practice Address - Country:US
Practice Address - Phone:703-548-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical