Healthcare Provider Details

I. General information

NPI: 1679963904
Provider Name (Legal Business Name): ERIN O'TOOLE-LYON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 EAST FRANKLIN STREET
RICHMOND VA
23223-7808
US

IV. Provider business mailing address

2514 EAST FRANKLIN STREET
RICHMOND VA
23223-7808
US

V. Phone/Fax

Practice location:
  • Phone: 804-255-9289
  • Fax:
Mailing address:
  • Phone: 804-255-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0904006918
License Number StateVA

VIII. Authorized Official

Name: MS. ERIN O'TOOLE-LYON
Title or Position: OWNER/PROVIDER
Credential: LCSW, CCTP
Phone: 804-255-9289