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Organization
LEGACY COUNSELING SERVICES LLC
Active
Organization
LEGACY COUNSELING SERVICES LLC
Active
Other names
Legacy Counseling Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EBONY NICKENS (OWNER)
(804) 677-0223
Entity
Organization
Contact information
Practice address
622 WINDBROOK CIR, NEWPORT NEWS, VA 23602-8847
(804) 677-0223
Mailing address
622 WINDBROOK CIR, NEWPORT NEWS, VA 23602-8847
(804) 677-0223
(804) 210-1550
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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