Organization
INDIGO LEGENDS ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATOYA SHENA WILSON LCSW-A, LCAS-A (OWNER)
(336) 268-5127
Entity
Organization
Contact information
Practice address
4761 QUEEN PIERRETTE ST, RALEIGH, NC 27610-8706
(336) 268-5127
Mailing address
4761 QUEEN PIERRETTE ST, RALEIGH, NC 27610-8706
(336) 268-5127
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
310400000X
Assisted Living Facility
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
04/24/2026
Last updated
05/06/2026
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