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General NPI Number Information
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NPI Number | 1730406935
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Entity Type | Organization
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Legal Business Name | LEGACY COUNSELING & CONSULTING GROUP, PLLC
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 351 WAGONER DR SUITE 310
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4608
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Country | US
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Telephone | 704-726-1270
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Fax | 866-462-1782
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Provider Business Mailing Address
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Address Line | PO BOX 25238
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5003
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Country | US
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Telephone | 704-726-1270
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Fax | 866-462-1782
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MS. TANISHA R JAMES
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Credential | LCSW
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Telephone | 704-726-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9295
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C005793
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005793
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License Number State | NC
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