Provider Demographics
NPI:1770176638
Name:LEGACEE INC
Entity type:Organization
Organization Name:LEGACEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-921-3247
Mailing Address - Street 1:7374 CREIGHTON PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4615
Mailing Address - Country:US
Mailing Address - Phone:804-412-8621
Mailing Address - Fax:800-322-0864
Practice Address - Street 1:7374 CREIGHTON PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4615
Practice Address - Country:US
Practice Address - Phone:804-412-8621
Practice Address - Fax:800-322-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225501554OtherNPI
VA1124309992OtherNPI