Healthcare Provider Details

I. General information

NPI: 1255643516
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES OF VA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 01/11/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 DICKENS RD STE 115
RICHMOND VA
23230-1952
US

IV. Provider business mailing address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-0122
  • Fax: 804-288-0123
Mailing address:
  • Phone: 540-774-7100
  • Fax: 540-774-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number272
License Number StateVA

VIII. Authorized Official

Name: FREIDA M KING
Title or Position: CONTROLLER
Credential:
Phone: 540-562-8473