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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