Provider Demographics
NPI:1902070972
Name:MATHEWS, TINA ANN (SUDCC IV)
Entity Type:Individual
Prefix:
First Name:TINA ANN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:SUDCC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BIRMINGHAM DR STE 240A
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1757
Mailing Address - Country:US
Mailing Address - Phone:858-208-0121
Mailing Address - Fax:858-381-9768
Practice Address - Street 1:120 BIRMINGHAM DR STE 240A
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1757
Practice Address - Country:US
Practice Address - Phone:858-208-0121
Practice Address - Fax:858-381-9768
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7347101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)