Basic Information
| Provider Information | |||||||||
| NPI: | 1902344351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGNOLIA COUNSELING SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 E NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217404014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016601662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 E NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217404014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016601662 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2017 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | PRICE | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3016601662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, LCPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LC7553 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.