FAMILY LEGACY MENTAL HEALTH SERVICES INC (NPI# 1932371655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932371655 |
| Entity Type | Organization |
| Organization Name | FAMILY LEGACY MENTAL HEALTH SERVICES INC |
| Practice Address |
1007 Broad St Durham NC 27705-4143 |
| Mailing Address |
1011 Schaub Dr Suite 200 Raleigh NC 27606-1862 |
| Practice Telephone | 9198342000 |
| Practice Fax Number | 9198342001 |
| Mailing Telephone | 9198342000 |
| Mailing Fax Number | 9198342001 |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2014-06-18 |
| Authorized Official Name | LISA DYAN STACEY (CEO) |
| Authorized Official Telephone | 9198342000 |
| Authorized Official Credential | B.S. Q.P |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
6102775 | NC | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
6107485 | NC | Behavioral Health & Social Service Providers |
| N | 103TC1900X |
Psychologist Specialization: Counseling |
6001168 | NC | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | 6105171 | NC | Behavioral Health & Social Service Providers |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
9300596 | NC | Allopathic & Osteopathic Physicians |
| N | 251B00000X | Case Management | Agencies | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8302925 | 05 | |
| NC | 5913953 | 05 | |
| NC | 6006506 | 05 | |
| NC | 8302411 | 05 |
| Street Address |
1007 BROAD ST |
| City | DURHAM |
| State | NC |
| Zip Code | 27705-4143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437499613 | Family Legacy Mental Health Services, Inc | Case Management | 1007 Broad St, Durham, NC 27705-4143 | 2013-02-25 |
| 1073806428 | Aspirations and Miracles Community Support LLC | Community/Behavioral Health | 1007 Broad St, Durham, NC 27705-4143 | 2011-05-18 |
| 1639225113 | Nature's Reflections, LLC | Community/Behavioral Health | 1007 Broad St, Durham, NC 27705-4143 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371755 | Tyler Beach, Lcsw, Pllc | Social Worker | 2740 Spencer Street, Durham, NC 27705 | 2019-11-20 |
| 1720635477 | Brittany W Fry | Registered Nurse | 2301 Erwin Road, Hafs Building, Room 6670, Durham, NC 27705 | 2019-08-19 |
| 1760968044 | Nicole D Moore | Social Worker | 1921 N. Pointe Dr, Suite 280, Durham, NC 27705 | 2018-07-19 |
| 1144757097 | Emileigh S Dowling | Physical Therapist | 3475 Erwin Rd Bldg 2, Durham, NC 27705 | 2017-05-22 |
| 1487195350 | Daniel Lynch | Physical Therapist | 3475 Erwin Road, Pepsico Building, Durham, NC 27705 | 2017-03-13 |
| 1780131839 | Michael A Fitzpatrick Iv | Physical Therapist | 3475 Erwin Rd Bldg 2nd, Durham, NC 27705 | 2016-09-07 |
| 1609241736 | Julia Power Constant | Physician Assistant | Dumc Box 3913, Durham, NC 27705 | 2015-12-01 |
| 1518344159 | Amanda Clark Coniglio | Internal Medicine | 2301 Erwin Rd # 3845, Durham, NC 27705 | 2015-05-04 |
| 1720486988 | Jennifer Dawn Pace | Physician Assistant | 1821 Hillandale Road Suite 24a, Duke Urgent Care, Durham, NC 27705 | 2014-12-19 |
| 1942612106 | Rachel Hibberd | Psychologist | 508 Fulton Avenue, Durham Va Medical Center, Durham, NC 27705 | 2014-05-22 |
| Find all providers in zip 27705 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417578667 | Alternative Choice Home Care Agency, LLC | Community/Behavioral Health | 800 N Mangum St Ste A-i, Durham, NC 27701-2260 | 2020-04-29 |
| 1316589138 | Monarch | Community/Behavioral Health | 1513 Piperwood Court, Durham, NC 27713 | 2019-10-14 |
| 1457916132 | Kalvin Franklin Jr. | Community/Behavioral Health | 2632 Cherry Creek Dr, Durham, NC 27703-5746 | 2019-05-07 |
| 1356804108 | Komkare Empowerment Center | Community/Behavioral Health | 1058 W Club Blvd Ste 232, Durham, NC 27701-1149 | 2019-04-09 |
| 1952883431 | Willow Oak Therapy, Pllc | Community/Behavioral Health | 3622 Lyckan Pkwy Ste 6006, Durham, NC 27707-2539 | 2018-08-31 |
| 1033634886 | Liasions Community Care | Community/Behavioral Health | 304a N Driver St, Durham, NC 27703-3058 | 2017-08-12 |
| 1447785134 | Nathaniel David Sawyer | Community/Behavioral Health | 5731 N Roxboro Rd, Durham, NC 27712-1427 | 2017-05-01 |
| 1376075556 | Baart Community Healthcare | Community/Behavioral Health | 800 N Mangum St Ste 300&400, Durham, NC 27701-2260 | 2017-03-28 |
| 1457807968 | Therapeutic Interventions Pllc | Community/Behavioral Health | 1058 W Club Blvd Ste 602, Durham, NC 27701-1159 | 2016-08-25 |
| 1912355298 | Harmony Healthcare Services, LLC | Community/Behavioral Health | 4004 Ben Franklin Blvd Ste C, Durham, NC 27704-2384 | 2016-05-27 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.