Provider Demographics
NPI:1811391832
Name:MATAS, KRISTIN LEIGH
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:MATAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SUNDOWN COVE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9188
Mailing Address - Country:US
Mailing Address - Phone:704-302-6974
Mailing Address - Fax:704-940-0869
Practice Address - Street 1:514 WILLIAMSON RD STE 411
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9227
Practice Address - Country:US
Practice Address - Phone:704-360-0803
Practice Address - Fax:704-940-0869
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS11051OtherLCMHC