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Organization
SOUTHERN MAGNOLIA THERAPY LLC
Active
Organization
SOUTHERN MAGNOLIA THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. INGRAM MALCOLM KERRY DIRTON LPC (CLINICAL DIRECTOR)
(864) 979-1325
Entity
Organization
Contact information
Practice address
25 N 173RD AVE APT 2, GOODYEAR, AZ 85338-6712
(864) 979-1325
Mailing address
25 N 173RD AVE APT 2, GOODYEAR, AZ 85338-6712
(864) 979-1325
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/11/2025
Last updated
05/05/2026
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