Provider Demographics
NPI:1700978863
Name:LUTHERAN FAMILY SERVICES OF VA
Entity type:Organization
Organization Name:LUTHERAN FAMILY SERVICES OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:FREIDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-562-8473
Mailing Address - Street 1:2000 W CLUB LN STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2428
Mailing Address - Country:US
Mailing Address - Phone:804-288-0122
Mailing Address - Fax:804-288-0123
Practice Address - Street 1:4901 DICKENS RD STE 115
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1952
Practice Address - Country:US
Practice Address - Phone:804-288-0122
Practice Address - Fax:804-288-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty