Provider Demographics
NPI:1104921717
Name:SUMNER-MATSON, KAREN SUE (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:SUMNER-MATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1421 ORCHARD LAKE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1645
Mailing Address - Country:US
Mailing Address - Phone:704-844-0181
Mailing Address - Fax:904-701-6279
Practice Address - Street 1:1421 ORCHARD LAKE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1645
Practice Address - Country:US
Practice Address - Phone:704-844-0181
Practice Address - Fax:904-701-6279
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106309Medicaid
NC6106309Medicaid