| NPI | 1902281843 |
|---|---|
| Doing Business As | MAGNOLIA ANGELS |
| Entity Type | Organization |
| Authorized Contact | STACY DENICE COWARD Administrator/ Owner 757-581-3897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001748) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001169953) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |