=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467322305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGNOLIA HOUSE MIND & WELLNESS LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2025
-----------------------------------------------------
Last Update Date | 11/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7288 S DUPONT HWY STE 6
-----------------------------------------------------
City | FELTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19943-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-526-0039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7288 S DUPONT HWY STE 6
-----------------------------------------------------
City | FELTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19943-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-526-0039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL OPERATIONS DIRECTOR/OWNER
-----------------------------------------------------
Name | DR. EMILY WHITE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 973-668-3463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------