Provider Demographics
NPI:1194273177
Name:MATTHEWS, INGRID WALKER (LCADC (MARYLAND))
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:WALKER
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LCADC (MARYLAND)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W PATRICK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5959
Mailing Address - Country:US
Mailing Address - Phone:240-626-1692
Mailing Address - Fax:304-724-8955
Practice Address - Street 1:141 W PATRICK ST STE 205
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5959
Practice Address - Country:US
Practice Address - Phone:240-626-1692
Practice Address - Fax:304-724-8955
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA 1913101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)