Provider Demographics
NPI:1255547816
Name:LILLY, TANYA M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:LILLY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BURKHOLDER ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2401
Mailing Address - Country:US
Mailing Address - Phone:304-890-7573
Mailing Address - Fax:
Practice Address - Street 1:550 N EISENHOWER DR APT A
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3109
Practice Address - Country:US
Practice Address - Phone:304-254-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009425631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical