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General NPI Number Information
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NPI Number | 1558895375
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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 | 04/18/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 6564 LOISDALE CT STE 600
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1829
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Country | US
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Telephone | 888-371-8112
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Fax | 866-936-3517
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Provider Business Mailing Address
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Address Line | PO BOX 36030
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-8001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KRISTIN HARRIS
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Credential |
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Telephone | 888-371-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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