Provider Demographics
NPI:1043608912
Name:LONDON FAMILY SERVICES
Entity type:Organization
Organization Name:LONDON FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:LATARSHA
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-831-7552
Mailing Address - Street 1:12388 WARWICK BLVD STE 306C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3820
Mailing Address - Country:US
Mailing Address - Phone:757-831-7552
Mailing Address - Fax:
Practice Address - Street 1:12388 WARWICK BLVD STE 306C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3820
Practice Address - Country:US
Practice Address - Phone:757-926-4641
Practice Address - Fax:757-926-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043608912Medicaid
VA1346407699Medicaid