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General NPI Number Information
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NPI Number | 1184844599
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Entity Type | Organization
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Legal Business Name | LDS FAMILY SERVICES
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 7621 LITTLE AVE SUITE 420
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City | CHARLOTTE
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State | NC
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Zip | 28226-8368
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Country | US
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Telephone | 704-541-5626
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Fax | 704-541-9284
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Provider Business Mailing Address
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Address Line | 7621 LITTLE AVE SUITE 420
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City | CHARLOTTE
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State | NC
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Zip | 28226-8368
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Country | US
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Telephone | 704-541-5626
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Fax | 704-541-9284
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAUL S GARRETT
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Credential | LCSW
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Telephone | 704-541-5626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 261QMO801X26
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License Number State | NC
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