Provider Demographics
NPI:1427565019
Name:TWEEDY, EUGENE ALPHONSO JR
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:ALPHONSO
Last Name:TWEEDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 POLK ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2935
Mailing Address - Country:US
Mailing Address - Phone:434-258-5633
Mailing Address - Fax:434-237-3605
Practice Address - Street 1:707 POLK ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2935
Practice Address - Country:US
Practice Address - Phone:434-258-5633
Practice Address - Fax:434-237-3605
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health