Provider Demographics
NPI:1982040606
Name:MATTHEWSON, CARMELESHA ANGELETTE (CHAIRLOSSPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:CARMELESHA
Middle Name:ANGELETTE
Last Name:MATTHEWSON
Suffix:
Gender:F
Credentials:CHAIRLOSSPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 944
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545
Mailing Address - Country:US
Mailing Address - Phone:919-914-1814
Mailing Address - Fax:
Practice Address - Street 1:1908 VILLAGE SQUIRE CIR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-5951
Practice Address - Country:US
Practice Address - Phone:919-914-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC21106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist