Provider Demographics
NPI:1699805176
Name:LDS SOCIAL SERVICES
Entity type:Organization
Organization Name:LDS SOCIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-836-2466
Mailing Address - Street 1:4431 MARKETING PL
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9556
Mailing Address - Country:US
Mailing Address - Phone:614-836-2466
Mailing Address - Fax:614-836-1865
Practice Address - Street 1:4431 MARKETING PL
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9556
Practice Address - Country:US
Practice Address - Phone:614-836-2466
Practice Address - Fax:614-836-1865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS SOCIAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty