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General NPI Number Information
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NPI Number | 1629423835
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Entity Type | Organization
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Legal Business Name | MAGNOLIA COUNSELING, LLC.
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 623 W MARKET ST
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City | PERKASIE
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State | PA
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Zip | 18944-1470
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Country | US
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Telephone | 610-306-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 438 ERIE AVE
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City | TELFORD
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State | PA
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Zip | 18969-2194
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Country | US
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Telephone | 610-306-9302
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/OWNER
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Name | SARAH YOUNG
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Credential |
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Telephone | 610-306-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC007998
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License Number State | PA
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