Basic Information
| Provider Information | |||||||||
| NPI: | 1316177710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | YOUILITE | ||||||||
| MiddleName: | SPEARS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPEARS | ||||||||
| OtherFirstName: | YOUILITE | ||||||||
| OtherMiddleName: | ARNIECE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LGSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 102 OAKBRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301346158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787151143 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 39A OAK HILL CT | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043216111 | ||||||||
| FaxNumber: | 4044172910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | MSW003551 | GA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 2380G | AL | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW004502 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.