Provider Demographics
NPI:1831478510
Name:MAGNOLIA COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MAGNOLIA COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-451-8693
Mailing Address - Street 1:3617 BRASELTON HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4667
Mailing Address - Country:US
Mailing Address - Phone:678-451-8693
Mailing Address - Fax:770-783-8927
Practice Address - Street 1:3617 BRASELTON HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4667
Practice Address - Country:US
Practice Address - Phone:678-451-8693
Practice Address - Fax:770-783-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003806251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health