Healthcare Provider Details

I. General information

NPI: 1437237849
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES OF VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

IV. Provider business mailing address

2609 MCVITTY RD
ROANOKE VA
24018-3513
US

V. Phone/Fax

Practice location:
  • Phone: 540-774-7100
  • Fax: 540-774-1084
Mailing address:
  • Phone: 540-774-7100
  • Fax: 540-774-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number272
License Number StateVA

VIII. Authorized Official

Name: FREIDA M KING
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 540-774-7100