Provider Demographics
NPI:1598848590
Name:LUTHERAN FAMILY SERVICES ACTT
Entity Type:Organization
Organization Name:LUTHERAN FAMILY SERVICES ACTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAGISTRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-968-2552
Mailing Address - Street 1:101 CONNER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7038
Mailing Address - Country:US
Mailing Address - Phone:919-968-2552
Mailing Address - Fax:919-968-4303
Practice Address - Street 1:101 CONNER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7038
Practice Address - Country:US
Practice Address - Phone:919-968-2552
Practice Address - Fax:919-968-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300820AMedicaid