Individual
JENNIE MATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
212 BLUE BALL AVE, ELKTON, MD 21921-5222
(410) 620-6077
(410) 620-6081
Mailing address
212 HAZEL RIDGE DR, WILMINGTON, DE 19810-1311
(302) 345-0487
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
MD
Enumeration date
04/12/2007
Last updated
07/09/2007
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