Provider Demographics
NPI:1578189130
Name:MATHEWS, DUSTINEY
Entity type:Individual
Prefix:
First Name:DUSTINEY
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1771
Mailing Address - Country:US
Mailing Address - Phone:740-577-9003
Mailing Address - Fax:740-577-9184
Practice Address - Street 1:219 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1771
Practice Address - Country:US
Practice Address - Phone:740-577-9003
Practice Address - Fax:740-577-9184
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHLCDCII.162095101YA0400X
OHCDCA.180996101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health