MEDICARE: MGG COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0601-1666C	AL

General Provider Information

NPI Number	:	1871079244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGG COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	3565 LORNA RIDGE DRIVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216
Country	:	US
Telephone Number	:	205-915-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 LORNA RIDGE DRIVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-5246
Country	:	US
Telephone Number	:	205-915-4968
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MARGE GAULDEN GILBERT
Credential	:	LICSW
Telephone Number	:	205-915-4968

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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