Provider Demographics
NPI:1447492699
Name:LIVING LEGACY, INC.
Entity type:Organization
Organization Name:LIVING LEGACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAPSW,LADACII
Authorized Official - Phone:901-672-7857
Mailing Address - Street 1:5865 RIDGEWAY CENTER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4014
Mailing Address - Country:US
Mailing Address - Phone:901-672-7857
Mailing Address - Fax:615-658-4559
Practice Address - Street 1:5865 RIDGEWAY CENTER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4014
Practice Address - Country:US
Practice Address - Phone:901-672-7857
Practice Address - Fax:615-658-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
TNLMSW0000006120251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty