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Individual

TIMOTHY ROBERT LYMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, LADC

Contact information

Practice address
631 HOGBACK RD, CROWN POINT, NY 12928-1815
(518) 570-1097
Mailing address
631 HOGBACK RD, CROWN POINT, NY 12928-1815
(518) 570-1097

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
151.0125941
VT
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
151.0125941
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
151.0125941
OFFICE OF PROFESSIONAL REGULATION
VT
Enumeration date
12/28/2018
Last updated
12/28/2018
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