Individual
MICHAEL S LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
43 CHAMPIONS AVE, BIG STONE GAP, VA 24219-1105
(276) 523-8300
(423) 467-3644
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701008234
VA
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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