Provider Demographics
NPI:1386479640
Name:LEGACY HEALTH FOUNDATION
Entity type:Organization
Organization Name:LEGACY HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DEMOND
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PRS
Authorized Official - Phone:757-738-4959
Mailing Address - Street 1:223 E CITY HALL AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1700
Mailing Address - Country:US
Mailing Address - Phone:757-738-4959
Mailing Address - Fax:443-320-9452
Practice Address - Street 1:223 E CITY HALL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1700
Practice Address - Country:US
Practice Address - Phone:757-738-4959
Practice Address - Fax:443-329-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health