Provider Demographics
NPI:1184844599
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES NC AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-541-5626
Mailing Address - Street 1:7621 LITTLE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8368
Mailing Address - Country:US
Mailing Address - Phone:704-541-5626
Mailing Address - Fax:704-541-9284
Practice Address - Street 1:7621 LITTLE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8368
Practice Address - Country:US
Practice Address - Phone:704-541-5626
Practice Address - Fax:704-541-9284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QMO801X26261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty