Provider Demographics
NPI:1851811780
Name:MCUMBER, MATTHEW JON (LCSW, LADAC, CADC II)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JON
Last Name:MCUMBER
Suffix:
Gender:M
Credentials:LCSW, LADAC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4003
Mailing Address - Country:US
Mailing Address - Phone:706-935-6442
Mailing Address - Fax:706-935-6441
Practice Address - Street 1:3091 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4003
Practice Address - Country:US
Practice Address - Phone:706-841-0500
Practice Address - Fax:423-464-7512
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1158101YA0400X
TN64641041C0700X
GA61101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty