Provider Demographics
NPI:1164767174
Name:LDC FAMILY SERVICES
Entity Type:Organization
Organization Name:LDC FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-400-1971
Mailing Address - Street 1:7459 OLD HICKORY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3631
Mailing Address - Country:US
Mailing Address - Phone:704-400-1971
Mailing Address - Fax:
Practice Address - Street 1:7459 OLD HICKORY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3631
Practice Address - Country:US
Practice Address - Phone:704-400-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health