Provider Demographics
NPI:1639413875
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 1:7950 NATIONS FORD RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
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:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management