Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003946054 |
---|---|
Provider Name | Amanda Matthews |
First Address | Charlotte, NC 28277-5518 |
Second Address | Albemarle, NC 28001-4932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 24/12/2014 |