Legacy Healing & Therapy Services Llc | |
2162 Astoria Cir Apt 403 Herndon VA 20170-4070 | |
(571) 306-2286 | |
Not Available |
Full Name | Legacy Healing & Therapy Services Llc |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 2162 Astoria Cir Apt 403, Herndon, Virginia |
Authorized Official Name and Position | Raven E Dickerson (OWNER) |
Authorized Official Contact | 5713062286 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Legacy Healing & Therapy Services Llc 2162 Astoria Cir Apt 403 Herndon VA 20170-4070 Ph: (571) 306-2286 | Legacy Healing & Therapy Services Llc 2162 Astoria Cir Apt 403 Herndon VA 20170-4070 Ph: (571) 306-2286 |
NPI Number | 1881297109 |
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Provider Enumeration Date | 11/19/2020 |
Last Update Date | 11/19/2020 |
Certification Date | 11/19/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881297109 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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