Provider Demographics
NPI:1750727228
Name:LUTHERAN SERVICES OF GEORGIA, INC..
Entity type:Organization
Organization Name:LUTHERAN SERVICES OF GEORGIA, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-875-0201
Mailing Address - Street 1:100 EDGEWOOD AVE NE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3026
Mailing Address - Country:US
Mailing Address - Phone:404-875-0201
Mailing Address - Fax:404-591-1030
Practice Address - Street 1:100 EDGEWOOD AVE NE
Practice Address - Street 2:SUITE 1800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3026
Practice Address - Country:US
Practice Address - Phone:404-875-0201
Practice Address - Fax:404-591-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty