Provider Demographics
NPI:1568219319
Name:LEGGS, DULONDA
Entity type:Individual
Prefix:
First Name:DULONDA
Middle Name:
Last Name:LEGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S VOSS RD, STE 110
Mailing Address - Street 2:#545
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:832-346-8802
Mailing Address - Fax:
Practice Address - Street 1:1415 S VOSS RD, STE 110
Practice Address - Street 2:#545
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:832-346-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities