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NPI Code Detail

MEDICARE: MR. TIMOTHY MAXWELL LILES SWT, CDCA, QMHS, CMS

MEDICARE: MR. TIMOTHY MAXWELL LILES SWT, CDCA, QMHS, CMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.161932OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLCDC.161605OH
3104100000XSocial WorkerS.1802660OH

General Provider Information

NPI Number : 1376062992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY MAXWELL LILES SWT, CDCA, QMHS, CMS
Provider Business Mailing Address
First Line : 923 FINDLAY ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-4148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 519 COURT ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-3933
Country : US
Telephone Number : 740-876-4370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2017
Last Update Date : 08/05/2024

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