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General NPI Number Information
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NPI Number | 1023901592
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Entity Type | Organization
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Legal Business Name | LEGACY HOLISTIC THERAPY PLLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 10215 HICKORYWOOD HILL AVE
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City | HUNTERVILLE
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State | NC
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Zip | 28078
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Country | US
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Telephone | 980-319-8197
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Fax | 980-734-3473
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Provider Business Mailing Address
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Address Line | 5818 HIGHLAND SHOPPES DR STE C5
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City | CHARLOTTE
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State | NC
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Zip | 28269-2654
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Country | US
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Telephone | 980-319-8197
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Fax | 980-734-3473
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Authorized Official
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Title or Position | OWNER
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Name | TINA TUTTLE
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Credential | LCMHCA
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Telephone | 980-319-8197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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