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General NPI Number Information
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NPI Number | 1063803328
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Entity Type | Organization
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Legal Business Name | THE LEGACY FOR CHILDREN AND FAMILIES
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 190 JAN DRIVE SUITE #10
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City | SHERWOOD
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State | AR
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Zip | 72120
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Country | US
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Telephone | 501-590-5121
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Fax |
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Provider Business Mailing Address
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Address Line | POB 6454
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City | SHERWOOD
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State | AR
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Zip | 72124
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Country | US
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Telephone | 501-590-5121
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | CHRISTASIA COLEMAN
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Credential | LPC
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Telephone | 501-590-5121
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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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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1302010
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License Number State | AR
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