Provider Demographics
NPI:1114398260
Name:MAGILL THERAPY LLC
Entity Type:Organization
Organization Name:MAGILL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-219-2412
Mailing Address - Street 1:5885 GLENRIDGE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5512
Mailing Address - Country:US
Mailing Address - Phone:404-219-2412
Mailing Address - Fax:404-745-0311
Practice Address - Street 1:5885 GLENRIDGE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5512
Practice Address - Country:US
Practice Address - Phone:404-219-2412
Practice Address - Fax:404-745-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty