=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578370276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIONMARK COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 OLD SCHOOLHOUSE RD
-----------------------------------------------------
City | EGGLESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24086-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-233-4110
-----------------------------------------------------
Fax | 276-233-4110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 OLD SCHOOLHOUSE RD
-----------------------------------------------------
City | EGGLESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24086-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-233-4110
-----------------------------------------------------
Fax | 276-233-4110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TIMOTHY W SMITH
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 276-233-4110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------