Organization
LEGACY TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LLOYD A WYNN (COO)
(973) 558-8514
Entity
Organization
Contact information
Practice address
4432 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6315
(410) 728-4491
(410) 728-5729
Mailing address
826 HOLLINS ST UNIT 1, BALTIMORE, MD 21201-1004
(973) 558-8514
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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