Provider Demographics
NPI:1073063285
Name:LEGACY EMPOWERMENT SERVICES
Entity Type:Organization
Organization Name:LEGACY EMPOWERMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESTIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-916-9115
Mailing Address - Street 1:7902 CADMIUM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9408
Mailing Address - Country:US
Mailing Address - Phone:704-916-9318
Mailing Address - Fax:
Practice Address - Street 1:7902 CADMIUM CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9408
Practice Address - Country:US
Practice Address - Phone:704-916-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7621251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health