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General NPI Number Information
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NPI Number | 1437505757
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Entity Type | Organization
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Legal Business Name | LEGACY COUNSELING LLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 263 MAIN ST
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City | WHITEHOUSE STATION
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State | NJ
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Zip | 08889-3737
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Country | US
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Telephone | 732-672-9051
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Fax |
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Provider Business Mailing Address
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Address Line | #1045 555 HIGH STREET STE 9
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City | MOUNT HOLLY
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State | NJ
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Zip | 08060-1062
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Country | US
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Telephone | 732-991-1556
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MALA DEVI DEODHARI-BENI
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Credential | LCSW
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Telephone | 732-672-9051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 44SC05563800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC05563800
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License Number State | NJ
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