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General NPI Number Information
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NPI Number | 1831679141
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Entity Type | Individual
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Provider Name | ANDREW R TYER LPC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 963 2ND ST SE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-6172
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Country | US
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Telephone | 434-566-0998
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Fax |
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Provider Business Mailing Address
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Address Line | 963 2ND ST SE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-6172
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701006011
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License Number State | VA
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