Provider Demographics
NPI:1235735135
Name:LEGACY COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:LEGACY COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-253-4398
Mailing Address - Street 1:8312 GOVERNOR GRAYSON WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3450
Mailing Address - Country:US
Mailing Address - Phone:443-253-4398
Mailing Address - Fax:410-203-2626
Practice Address - Street 1:8312 GOVERNOR GRAYSON WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3450
Practice Address - Country:US
Practice Address - Phone:443-253-4398
Practice Address - Fax:410-203-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty