Provider Demographics
NPI:1346871852
Name:OGUNTIMEHIN, SIOBHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:OGUNTIMEHIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:SIOBHAN
Other - Middle Name:CATHERINE
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2241 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1114
Mailing Address - Country:US
Mailing Address - Phone:434-847-8050
Mailing Address - Fax:434-847-4129
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-948-4831
Practice Address - Fax:434-948-4855
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist