Provider Demographics
NPI:1457853814
Name:L&G SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:L&G SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LASCHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-656-3340
Mailing Address - Street 1:192 DISCOVERY RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-4717
Mailing Address - Country:US
Mailing Address - Phone:434-656-3340
Mailing Address - Fax:434-656-3341
Practice Address - Street 1:102 SCHOOL ST STE A
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4200
Practice Address - Country:US
Practice Address - Phone:434-656-3340
Practice Address - Fax:434-656-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health