Provider Demographics
NPI:1003622366
Name:MATTHEWS, VERA ANN
Entity type:Individual
Prefix:MRS
First Name:VERA
Middle Name:ANN
Last Name:MATTHEWS
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 1:1573 BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-6430
Mailing Address - Country:US
Mailing Address - Phone:404-573-2503
Mailing Address - Fax:
Practice Address - Street 1:1573 BRUNSWICK ST
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-6430
Practice Address - Country:US
Practice Address - Phone:404-573-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903003873104100000X
DCLG200002635104100000X
GAMSW008000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker