# A LEGACY FAFILLED

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285027839
- **Authorized official:** RAYMOND HORNE (OWNER)
- **Authorized official phone:** (336) 383-7414

## Contact information

- **Practice address:** 3712 MIZELL RD APT F, GREENSBORO, NC 27405-4717
- **Practice address phone:** (336) 383-7414
- **Mailing address:** 3712 MIZELL RD APT F, GREENSBORO, NC 27405-4717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2015
- **Last updated:** 03/06/2015