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General NPI Number Information
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NPI Number | 1578361606
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Entity Type | Individual
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Provider Name | TYLER VIRGILIO
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Gender | Male
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 4000 MURRAY PL
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City | LYNCHBURG
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State | VA
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Zip | 24501-5004
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Country | US
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Telephone | 845-803-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 230 OASIS WAY UNIT 94B
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City | LYNCHBURG
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State | VA
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Zip | 24502-1175
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Country | US
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Telephone | 845-803-2812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0709026191
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License Number State | VA
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