Provider Demographics
NPI:1790080257
Name:MATTHEWS, KEISHA B (BS MA LCPC LPC ACS)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:BS MA LCPC LPC ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 RANDOM HILLS RD STE 36012587
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6051
Mailing Address - Country:US
Mailing Address - Phone:703-957-8975
Mailing Address - Fax:
Practice Address - Street 1:11325 RANDOM HILLS RD STE 360
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0972
Practice Address - Country:US
Practice Address - Phone:703-957-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional