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
—
—
Other
Enumeration date
03/11/2025
Last updated
05/05/2026
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