=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104784719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS LILLIAN EVE TIPTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 01/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 MURRAY PL
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-439-3283
-----------------------------------------------------
Fax | 434-818-0943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1176 COTTONTOWN MANOR DR APT 305
-----------------------------------------------------
City | FOREST
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24551-2552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-439-3283
-----------------------------------------------------
Fax | 434-818-0943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0709026261
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------