Provider Demographics
NPI:1346893096
Name:A NEW LEGACY FAMILY SERVICES
Entity Type:Organization
Organization Name:A NEW LEGACY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KORINN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-836-7212
Mailing Address - Street 1:206 E CLAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1326
Mailing Address - Country:US
Mailing Address - Phone:804-836-7212
Mailing Address - Fax:804-452-7481
Practice Address - Street 1:206 E CLAY ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1326
Practice Address - Country:US
Practice Address - Phone:804-836-7212
Practice Address - Fax:804-452-7481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A NEW LEGACY FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health