Healthcare Provider Details

I. General information

NPI: 1447492699
Provider Name (Legal Business Name): LIVING LEGACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

IV. Provider business mailing address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

V. Phone/Fax

Practice location:
  • Phone: 901-672-7857
  • Fax: 615-658-4559
Mailing address:
  • Phone: 901-672-7857
  • Fax: 615-658-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberLMSW0000006120
License Number StateTN

VIII. Authorized Official

Name: DR. SELENA NICOLE SMITH
Title or Position: DIRECTOR
Credential: PH.D., LAPSW,LADACII
Phone: 901-672-7857