Healthcare Provider Details

I. General information

NPI: 1962746842
Provider Name (Legal Business Name): LEGACY LIFE CARE PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 09/02/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 TROTWOOD AVE STE 11
COLUMBIA TN
38401-4750
US

IV. Provider business mailing address

100 N. BIGBY DR.
COLUMBIA TN
38401-4704
US

V. Phone/Fax

Practice location:
  • Phone: 931-626-1644
  • Fax: 931-381-5363
Mailing address:
  • Phone: 931-215-2182
  • Fax: 931-381-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1000000018345
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1000000018345
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1000000011378
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1000000011378
License Number StateTN

VIII. Authorized Official

Name: MS. LINDA R SMITH
Title or Position: CEO/PRESIDENT
Credential: N.H.A. M.P.S./IMFT
Phone: 931-215-2182