Provider Demographics
NPI:1023798287
Name:MATHEWS, MARK (MA, LGPC, NCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MA, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E CECIL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-4057
Mailing Address - Country:US
Mailing Address - Phone:484-849-1068
Mailing Address - Fax:
Practice Address - Street 1:102 E CECIL AVE STE D
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-4057
Practice Address - Country:US
Practice Address - Phone:484-849-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health