Provider Demographics
NPI:1548534290
Name:SIXBERRY, MATTHEW O
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:O
Last Name:SIXBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 GREEN VALLEY RD
Mailing Address - Street 2:200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2155
Mailing Address - Country:US
Mailing Address - Phone:336-663-1554
Mailing Address - Fax:
Practice Address - Street 1:717 GREEN VALLEY RD
Practice Address - Street 2:200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2155
Practice Address - Country:US
Practice Address - Phone:336-663-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1431106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist