| Doctor Name: | LATASHA MATTHEWS |
| NPI Number: | 1245508993 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 006599 |
| Business Practice Address: | 3996 Clairmont Rd Chamblee, GA - 303414938 |
| Business Phone Number: | 4049142521 |
| Business Fax Number: | |
| Mailing Address: | 392 Clearsprings Dr, LAWRENCEVILLE |
| State: | GA |
| Postal Code: | 300466881 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2011 |
| NPI Last Update Date: | 12/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 006599 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |