MEDICARE: MR. DALLAS CRAIG LEGATES MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.11216	SC

General Provider Information

NPI Number	:	1649153834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALLAS CRAIG LEGATES MS, LPC

Provider Business Mailing Address
First Line	:	111 SQUIRREL LN
Second Line	:
City	:	DORCHESTER
State	:	SC
Zip	:	29437-3844
Country	:	US
Telephone Number	:	843-200-8334
Fax Number	:

Provider Business Practice Location Address
First Line	:	29C LEINBACH DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6989
Country	:	US
Telephone Number	:	843-792-1461
Fax Number	:	843-792-2254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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