Basic Information
Provider Information
NPI: 1528735867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYRNE
FirstName: DEVIN
MiddleName: PATRICK
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 JEFFERSON ST STE 2C
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245041724
CountryCode: US
TelephoneNumber: 8552847483
FaxNumber: 6178070958
Practice Location
Address1: 1901 E FRANKLIN ST STE 108
Address2:  
City: RICHMOND
State: VA
PostalCode: 232236966
CountryCode: US
TelephoneNumber: 8552847483
FaxNumber: 6178070958
Other Information
ProviderEnumerationDate: 08/25/2021
LastUpdateDate: 08/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X0701010738VAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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