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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