Provider Demographics
NPI:1285113183
Name:LEGACY COUNSELING CENTERS
Entity type:Organization
Organization Name:LEGACY COUNSELING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LAPC
Authorized Official - Phone:678-664-4311
Mailing Address - Street 1:848 HIRAM ACWORTH HWY BLDG 100
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2286
Mailing Address - Country:US
Mailing Address - Phone:404-334-7575
Mailing Address - Fax:
Practice Address - Street 1:848 HIRAM ACWORTH HWY BLDG 100
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2286
Practice Address - Country:US
Practice Address - Phone:404-334-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LEGACY CONSORTIUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty