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General NPI Number Information
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NPI Number | 1649773235
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Entity Type | Organization
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Legal Business Name | LEGACY CLINICAL & CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 208 N 2ND AVE STE 1
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City | HOPEWELL
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State | VA
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Zip | 23860-2703
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Country | US
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Telephone | 804-506-0271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38178
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City | HENRICO
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State | VA
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Zip | 23231-0978
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Country | US
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Telephone | 804-506-0271
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHALETA EPPS
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Credential |
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Telephone | 804-721-9715
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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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