Provider Demographics
NPI:1861005431
Name:LEGACY COUNSELING AND CONSULTING OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:LEGACY COUNSELING AND CONSULTING OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-705-0005
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-5048
Mailing Address - Country:US
Mailing Address - Phone:864-705-0005
Mailing Address - Fax:
Practice Address - Street 1:62 BRIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-7452
Practice Address - Country:US
Practice Address - Phone:864-705-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health