Provider Demographics
NPI:1184053365
Name:PETERSON, MATTHEW (LCMHC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MERRIMON AVE # 1062
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2322
Mailing Address - Country:US
Mailing Address - Phone:828-713-4991
Mailing Address - Fax:
Practice Address - Street 1:215 CASTLEPOINTE CT UNIT 202
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-1019
Practice Address - Country:US
Practice Address - Phone:828-713-4991
Practice Address - Fax:828-669-4164
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10059101YM0800X
NC15657101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10059OtherLCMHC
NC10059AOtherNCBLPC