Provider Demographics
NPI:1962737866
Name:BARTHOLF, MATTHEW (LCAS, LPCA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BARTHOLF
Suffix:
Gender:M
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 HOUSTON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0605
Mailing Address - Country:US
Mailing Address - Phone:704-516-8166
Mailing Address - Fax:
Practice Address - Street 1:2915 HOUSTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-0605
Practice Address - Country:US
Practice Address - Phone:704-516-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health