Healthcare Provider Details

I. General information

NPI: 1053237347
Provider Name (Legal Business Name): LEGACY HEALING & COUNSELING COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BENSON DR STE 302
RALEIGH NC
27609-7381
US

IV. Provider business mailing address

3301 BENSON DR STE 302
RALEIGH NC
27609-7381
US

V. Phone/Fax

Practice location:
  • Phone: 919-321-1126
  • Fax: 888-307-5343
Mailing address:
  • Phone: 919-321-1126
  • Fax: 888-307-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY NOEL GREEN
Title or Position: LPC
Credential: MA, LPC, NCC
Phone: 919-321-1126