# LEGACY TREATMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LEGACY TREATMENT LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952877219
- **Legal business name:** LEGACY TREATMENT LLC
- **Authorized official:** LLOYD A WYNN (COO)
- **Authorized official phone:** (973) 558-8514

## Contact information

- **Practice address:** 4432 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6315
- **Practice address phone:** (410) 728-4491
- **Practice address fax:** (410) 728-5729
- **Mailing address:** 4432 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6315
- **Mailing address phone:** (410) 728-4491
- **Mailing address fax:** (410) 728-5729

## 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:** 10/15/2018
- **Last updated:** 10/15/2018