Provider Demographics
NPI:1790647808
Name:MATTHEWS, DALLAS JUNIOR II (LGPC)
Entity type:Individual
Prefix:MS
First Name:DALLAS
Middle Name:JUNIOR
Last Name:MATTHEWS
Suffix:II
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 RUGBY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3072
Mailing Address - Country:US
Mailing Address - Phone:844-868-1160
Mailing Address - Fax:
Practice Address - Street 1:4827 RUGBY AVE STE 301
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3072
Practice Address - Country:US
Practice Address - Phone:844-868-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP17306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health