Healthcare Provider Details

I. General information

NPI: 1508622887
Provider Name (Legal Business Name): CAITLIN V LYON, MSW, LICSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RIDGE RUNNER RD
WARDENSVILLE WV
26851-8366
US

IV. Provider business mailing address

81 RIDGE RUNNER RD
WARDENSVILLE WV
26851-8366
US

V. Phone/Fax

Practice location:
  • Phone: 304-867-9663
  • Fax:
Mailing address:
  • Phone: 304-813-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN LYON
Title or Position: OWNER
Credential: MSW, LICSW
Phone: 304-867-9663