Healthcare Provider Details

I. General information

NPI: 1346871852
Provider Name (Legal Business Name): SIOBHAN OGUNTIMEHIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SIOBHAN CATHERINE DWYER

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANGHORNE RD
LYNCHBURG VA
24501-1121
US

IV. Provider business mailing address

2241 LANGHORNE RD
LYNCHBURG VA
24501-1114
US

V. Phone/Fax

Practice location:
  • Phone: 434-948-4831
  • Fax: 434-948-4855
Mailing address:
  • Phone: 434-847-8050
  • Fax: 434-847-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001573
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: