Provider Demographics
NPI:1861063117
Name:MATTHEWS, CLIFFORD JR (LCSWA)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:MATTHEWS
Suffix:JR
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 ABERDEEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2424
Mailing Address - Country:US
Mailing Address - Phone:980-239-3214
Mailing Address - Fax:
Practice Address - Street 1:811 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2032
Practice Address - Country:US
Practice Address - Phone:704-908-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0138501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical