Provider Demographics
NPI:1679963904
Name:ERIN O'TOOLE-LYON, LLC
Entity Type:Organization
Organization Name:ERIN O'TOOLE-LYON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'TOOLE-LYON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CCTP
Authorized Official - Phone:804-255-9289
Mailing Address - Street 1:2514 EAST FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7808
Mailing Address - Country:US
Mailing Address - Phone:804-255-9289
Mailing Address - Fax:
Practice Address - Street 1:2514 EAST FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7808
Practice Address - Country:US
Practice Address - Phone:804-255-9289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA0904006918261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043469463Medicaid