Provider Demographics
NPI:1821655705
Name:MATTHEWS, TAYLER (LSATP, LADACII, CSAC)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LSATP, LADACII, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5477 MOORETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2108
Mailing Address - Country:US
Mailing Address - Phone:757-349-6285
Mailing Address - Fax:
Practice Address - Street 1:5477 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:757-349-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1439101YA0400X
AK4405101YA0400X
VA0718000655101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health