Individual
MARLENA NICOLE MATUSEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
501 BILLINGSLEY RD, CHARLOTTE, NC 28211-1009
(704) 358-2744
(704) 358-2945
Mailing address
PO BOX 601067, CHARLOTTE, NC 28260-1067
(704) 358-2744
(704) 358-2945
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103G00000X
Clinical Neuropsychologist
Primary
4499
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588705248
—
NC
05
—
PS0538
—
SC
Enumeration date
02/08/2007
Last updated
12/28/2016
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