Danielle Dessa Matlock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

253257 Issued in KY

Practice address

1203 American Greeting Card Rd
Corbin, KY 40701-4811

Phone

(606) 528-7010

NPI assigned

Jul 15, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Danielle Dessa Stansberry Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cumberland River Behavioral Health, Inc

  • Community/Behavioral Health Agency
  • Corbin, KY
  • NPI 1902023526
  Medicare reassignment NPD
• Isaiah House, Inc.

  • Substance Abuse Rehabilitation Facility
  • Willisburg, KY
  • NPI 1396086559
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1104233709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407020568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 AMERICAN GREETING CARD RD",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407014811",
            "telephone_number": "606-528-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATLOCK",
        "first_name": "DANIELLE",
        "middle_name": "DESSA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-15",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "253257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "STANSBERRY",
            "middle_name": "DESSA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Summer Martin
• Tamara Lynn Martin
• Vonda Martin
• Mikayla Marissa Mason
• Mary Massey
• Mary Ann Matney-Hughes, RN,BSN
• May Pain Institute LTD
• Victoria Colheen May, LPCC, LCADC
• Russell David Maynard, BA
• Stacy Lynn Mayne, MSW

• Clinical Social Worker in Corbin, KY
• Providers in Corbin, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.