Provider Demographics
NPI:1346941499
Name:MAGNOLIA COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:MAGNOLIA COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PETRINA
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-297-6027
Mailing Address - Street 1:6814 WYCK FARM WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6108
Mailing Address - Country:US
Mailing Address - Phone:910-297-6027
Mailing Address - Fax:
Practice Address - Street 1:4010 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6841
Practice Address - Country:US
Practice Address - Phone:910-297-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health