Provider Demographics
NPI:1134398688
Name:GARLAND, MATTHEW LANCE (MA , CH, LPCI)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LANCE
Last Name:GARLAND
Suffix:
Gender:M
Credentials:MA , CH, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 GREEN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6017
Mailing Address - Country:US
Mailing Address - Phone:843-766-6278
Mailing Address - Fax:
Practice Address - Street 1:2366 ASHLEY RIVER RD
Practice Address - Street 2:BUILDING #8
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4754
Practice Address - Country:US
Practice Address - Phone:843-225-2024
Practice Address - Fax:843-225-2024
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190166Medicaid