Provider Demographics
NPI:1467269530
Name:LEGACY COUNSELING CENTER LLC
Entity type:Organization
Organization Name:LEGACY COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:COUNSELING
Authorized Official - Last Name:CRAVILLION
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-551-0367
Mailing Address - Street 1:211 DUNBAR CAVE RD STE 235C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8847
Mailing Address - Country:US
Mailing Address - Phone:931-551-0367
Mailing Address - Fax:
Practice Address - Street 1:211 DUNBAR CAVE RD STE 235C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8847
Practice Address - Country:US
Practice Address - Phone:931-551-0367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty