Provider Demographics
NPI:1588071708
Name:LEGETTE, KIA
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:LEGETTE
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 1:1441 22ND ST APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1669
Mailing Address - Country:US
Mailing Address - Phone:678-667-3013
Mailing Address - Fax:
Practice Address - Street 1:1441 22ND ST APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1669
Practice Address - Country:US
Practice Address - Phone:678-667-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171400000XOther Service ProvidersHealth & Wellness Coach
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable