Provider Demographics
NPI:1720787393
Name:LEGACY COUNSELING AND WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:LEGACY COUNSELING AND WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-426-3859
Mailing Address - Street 1:1800 GERMAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4184
Mailing Address - Country:US
Mailing Address - Phone:804-426-3859
Mailing Address - Fax:
Practice Address - Street 1:1800 GERMAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4184
Practice Address - Country:US
Practice Address - Phone:804-426-3859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health