Provider Demographics
NPI:1902473861
Name:MATTHEWS, LEON DEHAVEN (AMFTA)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:DEHAVEN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:AMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10834 SALTMARSH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6895
Mailing Address - Country:US
Mailing Address - Phone:704-491-2507
Mailing Address - Fax:
Practice Address - Street 1:10834 SALTMARSH LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6895
Practice Address - Country:US
Practice Address - Phone:704-491-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist