1184825788 NPI number — TIMOTHY ROGER LYONS LICSW LCSWC

Table of content: DIANNA MCKNIGHT (NPI 1306312590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184825788 NPI number — TIMOTHY ROGER LYONS LICSW LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYONS
Provider First Name:
TIMOTHY
Provider Middle Name:
ROGER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW LCSWC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184825788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6911 WOODLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAKOMA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-461-2231
Provider Business Mailing Address Fax Number:
202-543-4476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 7TH ST SE
Provider Second Line Business Practice Location Address:
CAPITOL HILL CENTER
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-461-2231
Provider Business Practice Location Address Fax Number:
202-543-4476
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  09618 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LC303152 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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