Provider Demographics
NPI:1639470545
Name:MATTHEWS PSYCHOTHERAPY ASSOCIATES, PA
Entity Type:Organization
Organization Name:MATTHEWS PSYCHOTHERAPY ASSOCIATES, PA
Other - Org Name:SUE EVANS, PMHCNS-BC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC
Authorized Official - Phone:704-814-9500
Mailing Address - Street 1:1114 SAM NEWELL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-814-9500
Mailing Address - Fax:704-846-1293
Practice Address - Street 1:1114 SAM NEWELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-814-9500
Practice Address - Fax:704-846-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43456163WP0807X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty