Healthcare Provider Details

I. General information

NPI: 1437326154
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 WALES CT
THOMPSONS STATION TN
37179-5297
US

IV. Provider business mailing address

4823 N ROYAL ATLANTA DR
TUCKER GA
30084-3806
US

V. Phone/Fax

Practice location:
  • Phone: 615-599-0395
  • Fax:
Mailing address:
  • Phone: 770-939-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW0000005835
License Number StateTN

VIII. Authorized Official

Name: CHRISTOPHER YOUNG
Title or Position: DIRECTOR
Credential: LCSW
Phone: 770-939-2121