Healthcare Provider Details

I. General information

NPI: 1659878908
Provider Name (Legal Business Name): BEYOND SOBER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117A TRADEWYND DR
LYNCHBURG VA
24502-3112
US

IV. Provider business mailing address

104 OVERLINK CT
LYNCHBURG VA
24503-3200
US

V. Phone/Fax

Practice location:
  • Phone: 434-215-4430
  • Fax:
Mailing address:
  • Phone: 434-215-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID C MARTIN
Title or Position: OWNER, COUNSELOR IN RESIDENCE
Credential: MA
Phone: 434-215-4430