Individual
MATTHEW FUQUA
Active
Individual
MATTHEW FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
11212-M
AR
1041C0700X
Clinical Social Worker
2019027209
MO
1041C0700X
Clinical Social Worker
Primary
2022042255
MO
1041C0700X
Clinical Social Worker
PENDING
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
AR
Enumeration date
04/16/2021
Last updated
06/09/2026
Update your record
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