Provider Demographics
NPI:1841655255
Name:LRD HOLDINGS
Entity type:Organization
Organization Name:LRD HOLDINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPUIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-904-6875
Mailing Address - Street 1:10720 CARMEL COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3785
Mailing Address - Country:US
Mailing Address - Phone:704-904-6875
Mailing Address - Fax:704-625-3695
Practice Address - Street 1:10720 CARMEL COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3785
Practice Address - Country:US
Practice Address - Phone:704-904-6875
Practice Address - Fax:704-625-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty