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General NPI Number Information
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NPI Number | 1770510075
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Entity Type | Organization
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Legal Business Name | LEGACY COUNSELING CENTER INC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 4054 MCKINNEY AVE STE 102
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City | DALLAS
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State | TX
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Zip | 75204-2050
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Country | US
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Telephone | 214-520-6308
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Fax |
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Provider Business Mailing Address
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Address Line | 4054 MCKINNEY AVE STE 102
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City | DALLAS
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State | TX
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Zip | 75204-2050
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Country | US
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Telephone | 214-520-6308
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MELISSA GROVE
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Credential | LPC, M.S.
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Telephone | 214-520-6308
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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 | S18803
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License Number State | TX
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