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Organization

THE LEGACY WAY

Active
Parent organization
LATTICE FOUNDATION
Organization subpart
Yes

Provider details

NPI number
Legal business name
LATTICE FOUNDATION
Authorized official
SHELBY ROCHE LPC (DIRECTOR OF THERAPEUTICS)
(516) 902-4714
Entity
Organization

Contact information

Practice address
439 TARA OAKS TRL, LAWRENCEVILLE, GA 30043-3046
(908) 361-7811
Mailing address
439 TARA OAKS TRL, LAWRENCEVILLE, GA 30043-3046
(908) 361-7811

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Enumeration date
03/31/2026
Last updated
03/31/2026
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