Provider Demographics
NPI:1689103251
Name:LEGACY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LEGACY COUNSELING SERVICES, LLC
Other - Org Name:LEGACY COUNSELING AND CONSULTING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-481-0004
Mailing Address - Street 1:6715 STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1831
Mailing Address - Country:US
Mailing Address - Phone:864-481-0004
Mailing Address - Fax:864-438-5894
Practice Address - Street 1:6715 STATE PARK RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1831
Practice Address - Country:US
Practice Address - Phone:864-481-0004
Practice Address - Fax:864-438-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)