Provider Demographics
NPI:1952796179
Name:MATHEWS, JOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 LIFESTYLE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4807
Mailing Address - Country:US
Mailing Address - Phone:804-317-5756
Mailing Address - Fax:804-482-2590
Practice Address - Street 1:4581 LIFESTYLE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4807
Practice Address - Country:US
Practice Address - Phone:804-317-5756
Practice Address - Fax:804-510-0929
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040089191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical