Provider Demographics
NPI:1124624739
Name:MAGNOLIA HEALING HEARS COUNSELING CENTER LLC
Entity type:Organization
Organization Name:MAGNOLIA HEALING HEARS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:757-286-8555
Mailing Address - Street 1:6259 TERRAPIN DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3806
Mailing Address - Country:US
Mailing Address - Phone:757-286-8555
Mailing Address - Fax:
Practice Address - Street 1:6259 TERRAPIN DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3806
Practice Address - Country:US
Practice Address - Phone:757-286-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty