Provider Demographics
NPI:1104460385
Name:MATTHEWS, QUIANA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:QUIANA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA RD STE 17B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0449
Mailing Address - Country:US
Mailing Address - Phone:706-496-3479
Mailing Address - Fax:762-320-5363
Practice Address - Street 1:4210 COLUMBIA RD STE 17B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0449
Practice Address - Country:US
Practice Address - Phone:706-496-3479
Practice Address - Fax:762-320-5363
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002061101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health