Provider Demographics
NPI:1144091224
Name:KOHMAN, MATTHEW GIRARD (MA, QMHP-T, CSAC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GIRARD
Last Name:KOHMAN
Suffix:
Gender:M
Credentials:MA, QMHP-T, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1216
Mailing Address - Country:US
Mailing Address - Phone:804-814-6621
Mailing Address - Fax:
Practice Address - Street 1:300 TURNER RD STE K
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6431
Practice Address - Country:US
Practice Address - Phone:804-330-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)