Provider Demographics
NPI:1184825788
Name:LYONS, TIMOTHY ROGER (LICSW LCSWC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROGER
Last Name:LYONS
Suffix:
Gender:M
Credentials:LICSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:301-461-2231
Mailing Address - Fax:202-543-4476
Practice Address - Street 1:530 7TH ST SE
Practice Address - Street 2:CAPITOL HILL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:301-461-2231
Practice Address - Fax:202-543-4476
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096181041C0700X
DCLC3031521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical