Individual
MATTHEW OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
504 WILBORN AVE, SOUTH BOSTON, VA 24592-3120
(434) 517-3020
Mailing address
2200 CLAYS MILL RD, HALIFAX, VA 24558-2816
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701014549
VA
Other
Enumeration date
02/25/2025
Last updated
02/25/2025
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