Provider Demographics
NPI:1568928646
Name:MAGIC CITY COUNSELING, LLC
Entity Type:Organization
Organization Name:MAGIC CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERNELL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-276-7279
Mailing Address - Street 1:5015 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-1452
Mailing Address - Country:US
Mailing Address - Phone:205-276-7279
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND DR STE 109
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35226-3737
Practice Address - Country:US
Practice Address - Phone:205-276-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty