Provider Demographics
NPI:1982175469
Name:MAGNOLIA WELLNESS GROUP, PC
Entity Type:Organization
Organization Name:MAGNOLIA WELLNESS GROUP, PC
Other - Org Name:MAGNOLIA MENTAL HEALTH ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-375-7500
Mailing Address - Street 1:809 WILD TURKEY PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4265
Mailing Address - Country:US
Mailing Address - Phone:910-375-7500
Mailing Address - Fax:
Practice Address - Street 1:1904 EASTWOOD RD STE 313
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5728
Practice Address - Country:US
Practice Address - Phone:910-375-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health