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General NPI Number Information
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NPI Number | 1497515233
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 4909 WATERS EDGE DR
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City | RALEIGH
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State | NC
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Zip | 27606-2462
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Country | US
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Telephone | 919-307-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 409 BOLIN CT
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City | RALEIGH
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State | NC
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Zip | 27603-2274
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Country | US
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Telephone | 919-307-9826
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/LICENSED PSYCHOLOGIST
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Name | DR. JESSICA REED
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Credential | PSYD
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Telephone | 919-307-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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