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General NPI Number Information
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NPI Number | 1114291408
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Entity Type | Organization
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Legal Business Name | THE L.E.G.A.C.Y CASE MANAGEMENT INC
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Dates
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Enumeration Date | 03/04/2012
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Last Update Date | 03/04/2012
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Provider Practice Location Address
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Address Line | 1512 GILLIONVILLE RD STE 5E
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City | ALBANY
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State | GA
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Zip | 31707-0901
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Country | US
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Telephone | 478-697-5089
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 GILLIONVILLE RD STE 5E
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City | ALBANY
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State | GA
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Zip | 31707-0901
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Country | US
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Telephone | 478-697-5089
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CINDREKA DELMONICA MARSHALL-PETERSON
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Credential | MSW
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Telephone | 478-697-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | GA
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