Healthcare Provider Details

I. General information

NPI: 1083524441
Provider Name (Legal Business Name): THE MAGNOLIA THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 W HAMLIN RD
ROCHESTER HILLS MI
48309-3312
US

IV. Provider business mailing address

1693 W HAMLIN RD
ROCHESTER HILLS MI
48309-3312
US

V. Phone/Fax

Practice location:
  • Phone: 248-905-1862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY GREENE
Title or Position: OWNER
Credential: MA, LPC
Phone: 313-439-4782