Provider Demographics
NPI:1215556972
Name:LYONS, VICTORIA A (MHRT-C/B, CADC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:LYONS
Suffix:
Gender:F
Credentials:MHRT-C/B, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-0170
Mailing Address - Country:US
Mailing Address - Phone:207-647-5629
Mailing Address - Fax:207-647-2803
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:207-647-2803
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker