Provider Demographics
NPI:1659878908
Name:BEYOND SOBER LLC
Entity Type:Organization
Organization Name:BEYOND SOBER LLC
Other - Org Name:BEYOND SOBER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, COUNSELOR IN RESIDENCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:434-215-4430
Mailing Address - Street 1:104 OVERLINK CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3200
Mailing Address - Country:US
Mailing Address - Phone:434-215-4430
Mailing Address - Fax:
Practice Address - Street 1:117A TRADEWYND DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3112
Practice Address - Country:US
Practice Address - Phone:434-215-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty