Provider Demographics
NPI:1801304134
Name:MATTHEWS, TAHIRA C (MA, LPC, NCC, C-SSW)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:C
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA, LPC, NCC, C-SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BRANCH BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3606
Mailing Address - Country:US
Mailing Address - Phone:862-202-5320
Mailing Address - Fax:
Practice Address - Street 1:210 BRANCH BROOK DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3606
Practice Address - Country:US
Practice Address - Phone:862-202-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00958400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional