Healthcare Provider Details

I. General information

NPI: 1437505757
Provider Name (Legal Business Name): LEGACY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MAIN ST
WHITEHOUSE STATION NJ
08889-3737
US

IV. Provider business mailing address

#1045 555 HIGH STREET STE 9
MOUNT HOLLY NJ
08060-1062
US

V. Phone/Fax

Practice location:
  • Phone: 732-672-9051
  • Fax:
Mailing address:
  • Phone: 732-991-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05563800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC05563800
License Number StateNJ

VIII. Authorized Official

Name: MALA DEVI DEODHARI-BENI
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 732-672-9051