Provider Demographics
NPI:1245649730
Name:MATOS, JODI (LMFT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 INDEPENDENCE BLVD
Mailing Address - Street 2:STE.321
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2986
Mailing Address - Country:US
Mailing Address - Phone:757-490-0377
Mailing Address - Fax:757-497-1327
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:STE.321
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-490-0377
Practice Address - Fax:757-497-1327
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2021-02-25
Deactivation Date:2021-01-29
Deactivation Code:
Reactivation Date:2021-02-25
Provider Licenses
StateLicense IDTaxonomies
VA0717001320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist