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Organization

LEGACY HEALING & THERAPY SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RAVEN E DICKERSON LCSW (OWNER)
(571) 306-2286
Entity
Organization

Contact information

Practice address
2162 ASTORIA CIR APT 403, HERNDON, VA 20170-4070
(571) 306-2286
Mailing address
2162 ASTORIA CIR APT 403, HERNDON, VA 20170-4070
(571) 306-2286

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Enumeration date
11/19/2020
Last updated
11/19/2020
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