| Magnolia Angels | |
|
1122 London Blvd Portsmouth VA 23704-2246 | |
| (757) 581-3897 | |
| Not Available |
| Full Name | Magnolia Angels |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1122 London Blvd, Portsmouth, Virginia |
| Authorized Official Name and Position | Stacy Denice Coward (ADMINISTRATOR/ OWNER) |
| Authorized Official Contact | 7575813897 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Angels 1122 London Blvd Portsmouth VA 23704-2246 Ph: (757) 581-3897 | Magnolia Angels 1122 London Blvd Portsmouth VA 23704-2246 Ph: (757) 581-3897 |
| NPI Number | 1902281843 |
|---|---|
| Provider Enumeration Date | 07/21/2015 |
| Last Update Date | 07/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902281843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810001748 (Virginia) | Primary |
| 163WP0808X | Registered Nurse - Psychiatric/mental Health | 0001169953 (Virginia) | Secondary |
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