Provider Demographics
NPI:1043245632
Name:MATTOX, NANCY NONE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:NONE
Last Name:MATTOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 ELM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-3165
Mailing Address - Country:US
Mailing Address - Phone:804-784-1291
Mailing Address - Fax:804-354-2536
Practice Address - Street 1:422 ELM CREEK DR
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-3165
Practice Address - Country:US
Practice Address - Phone:804-784-1291
Practice Address - Fax:804-354-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical