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General NPI Number Information
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NPI Number | 1174142715
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Entity Type | Organization
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Legal Business Name | LEGACY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 4500 FORBES BLVD STE 200
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City | LANHAM
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State | MD
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Zip | 20706-6316
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Country | US
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Telephone | 301-265-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 11203 CHAMPLAIN CIR
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City | BOWIE
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State | MD
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Zip | 20720-3490
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Country | US
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Telephone | 301-538-6103
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PSYCHOTHERAPIST
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Name | AMINA ALEEM HALL
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Credential | LCSW
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Telephone | 301-265-6150
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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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