Provider Demographics
NPI:1841473212
Name:MATHEWS, TELINA FAYE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TELINA
Middle Name:FAYE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73081
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-3081
Mailing Address - Country:US
Mailing Address - Phone:919-886-8008
Mailing Address - Fax:919-477-1848
Practice Address - Street 1:106 W CHURCH ST STE H
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9765
Practice Address - Country:US
Practice Address - Phone:919-886-8008
Practice Address - Fax:919-477-1848
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6824101YP2500X, 101YS0200X
NCS6824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool