| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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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