Healthcare Provider Details

I. General information

NPI: 1275958803
Provider Name (Legal Business Name): LEGACY ALLIANCE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 ANDOVER CAY BLVD
ORLANDO FL
32825-2739
US

IV. Provider business mailing address

3948 ANDOVER CAY BLVD
ORLANDO FL
32825-2739
US

V. Phone/Fax

Practice location:
  • Phone: 407-399-7489
  • Fax: 407-282-9377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH6719
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. HELEN BENN
Title or Position: PRESIDENT/CEO
Credential: PH.D., LMHC
Phone: 407-399-7489