Healthcare Provider Details

I. General information

NPI: 1831996404
Provider Name (Legal Business Name): MAGNOLIA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 CAFFEY ST STE 2A
HERNANDO MS
38632-1710
US

IV. Provider business mailing address

2446 CAFFEY ST STE 2A
HERNANDO MS
38632-1710
US

V. Phone/Fax

Practice location:
  • Phone: 662-863-4628
  • Fax:
Mailing address:
  • Phone: 662-863-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JULIE FERGUSON
Title or Position: OWNER
Credential: LCSW
Phone: 662-863-4628