Provider Demographics
NPI:1760754089
Name:LDC FAMILY SERVICES
Entity Type:Organization
Organization Name:LDC FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:721 HYDRANGEA CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7258
Mailing Address - Country:US
Mailing Address - Phone:704-400-1971
Mailing Address - Fax:866-405-5481
Practice Address - Street 1:34 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1321
Practice Address - Country:US
Practice Address - Phone:704-400-1971
Practice Address - Fax:866-405-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty