| Magnolia Wellness, Llc | |
|
302 State St Suite 201 New London CT 06320-2310 | |
| (860) 439-1300 | |
| Not Available |
| Full Name | Magnolia Wellness, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 302 State St, New London, Connecticut |
| Authorized Official Name and Position | Gizelle E Tircuit-posey (OWNER) |
| Authorized Official Contact | 8604391300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Wellness, Llc 302 State St Suite 201 New London CT 06320 Ph: (860) 439-1300 | Magnolia Wellness, Llc 302 State St Suite 201 New London CT 06320-2310 Ph: (860) 439-1300 |
| NPI Number | 1760913347 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 03/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760913347 | NPI | - | NPPES |
| CBHP007958 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 002923 (Connecticut) | Primary |
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