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Organization

LEGACY LIFE COUNSELING & CONSULTING SERVICES, PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LA TOSHA A. LYMON MA, LPC (CEO/PROGRAM DIRECTOR)
(248) 270-7092
Entity
Organization

Contact information

Practice address
31268 SHORECREST DR APT 24302, NOVI, MI 48377-1182
(248) 270-7092
Mailing address
17360 W 12 MILE RD STE 104, SOUTHFIELD, MI 48076-2117
(248) 270-7092

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
Primary
106H00000X
Marriage & Family Therapist
251S00000X
Community/Behavioral Health Agency
261QC1500X
Community Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center
347D00000X
Train

Other

Enumeration date
07/10/2019
Last updated
02/10/2021
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