Provider Demographics
NPI:1700403714
Name:MY MOTHERHOOD MAGIC
Entity Type:Organization
Organization Name:MY MOTHERHOOD MAGIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:ALESAUNDRA
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-596-1110
Mailing Address - Street 1:42 GOVERNORS PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1911
Mailing Address - Country:US
Mailing Address - Phone:614-596-1110
Mailing Address - Fax:
Practice Address - Street 1:42 GOVERNORS PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1911
Practice Address - Country:US
Practice Address - Phone:614-596-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty