=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649153834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALLAS CRAIG LEGATES MS, LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29C LEINBACH DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-6989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-792-1461
-----------------------------------------------------
Fax | 843-792-2254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 SQUIRREL LN
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29437-3844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-200-8334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC.11216
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------